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Anteroposterior (AP) syrinx diameter was measured at C2 (SX\n                      <jats:sub>2<\/jats:sub>\n                      ) and C7 (SX\n                      <jats:sub>7<\/jats:sub>\n                      ) for patients with syringomyelia. Tonsillar ectopia was measured for all patients in the CM\u2009+\u2009SM and CM-only cohorts. AP diameter of the bony spinal canal at C2 (SC\n                      <jats:sub>2<\/jats:sub>\n                      ) and C7 (SC\n                      <jats:sub>7<\/jats:sub>\n                      ) was measured for all patients. Patients were stratified by age and sex in secondary analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      357 patients had CM\u2009+\u2009SM and 217 patients had CM-only. Both cohorts had larger SC\n                      <jats:sub>2<\/jats:sub>\n                      (p\u2009&lt;\u20090.0001) and SC\n                      <jats:sub>7<\/jats:sub>\n                      (p\u2009&lt;\u20090.0001) compared to controls. CM\u2009+\u2009SM had larger SC\n                      <jats:sub>7<\/jats:sub>\n                      (p\u2009&lt;\u20090.0001) but not SC\n                      <jats:sub>2<\/jats:sub>\n                      (p\u2009=\u20090.10) compared to CM-only. Increased SX\n                      <jats:sub>2<\/jats:sub>\n                      was associated with increased SC\n                      <jats:sub>2<\/jats:sub>\n                      (p\u2009&lt;\u20090.0001); both SX\n                      <jats:sub>2<\/jats:sub>\n                      and SX\n                      <jats:sub>7<\/jats:sub>\n                      were significantly associated with increases in SC\n                      <jats:sub>7<\/jats:sub>\n                      (p\u2009&lt;\u20090.0001). Syringes\u2009\u2265\u20093\u00a0mm were associated with larger SC\n                      <jats:sub>2<\/jats:sub>\n                      and SC\n                      <jats:sub>7<\/jats:sub>\n                      compared to syringes\u2009&lt;\u20093\u00a0mm (p\u2009\u2264\u20090.002). SC\n                      <jats:sub>2<\/jats:sub>\n                      and SC\n                      <jats:sub>7<\/jats:sub>\n                      for syringes\u2009&lt;\u20093\u00a0mm were not significantly different from CM-only. Children with CM\u2009+\u2009SM in early childhood\/adolescence experienced the greatest percentage spinal canal dilation. Females experienced greater spinal canal dilation than similarly-aged males.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with CM\u2009\u00b1\u2009SM experience significant increases in bony cervical spinal canal diameter during development. Syringes\u2009\u2265\u20093\u00a0mm with CM are associated with further canal dilation of the spinal canal at syrinx level. The degree of spinal canal dilation appears to be age- and sex-dependent.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00381-026-07233-9","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T23:52:06Z","timestamp":1774569126000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations of Chiari-1 malformation and syringomyelia with osseous cervical spinal canal diameter in the pediatric spine"],"prefix":"10.1007","volume":"42","author":[{"given":"Alexander T.","family":"Yahanda","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Devin W.","family":"Kolmetzky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivek P.","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer M.","family":"Strahle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean D.","family":"McEvoy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabe","family":"Haller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thanda","family":"Meehan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian A.","family":"Kelly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott J.","family":"Luhmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua S.","family":"Shimony","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James C.","family":"Torner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David D.","family":"Limbrick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"7233_CR1","doi-asserted-by":"publisher","first-page":"161","DOI":"10.3171\/2014.10.PEDS14295","volume":"15","author":"A Arnautovic","year":"2015","unstructured":"Arnautovic A, Splavski B, Boop FA, Arnautovic KI (2015) Pediatric and adult Chiari malformation type I surgical series 1965\u20132013: a review of demographics, operative treatment, and outcomes. 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