A morphometric study of the odontoid process using three-dimensional computed tomography (3-D CT) reconstruction

Yıl 2019, Cilt: 13 Sayı: 2, 80 - 86, 31.08.2019

Ece Alım Kerem Atalar İsmail Nadir Gulekon

Öz

Objectives: The aim of this study was to evaluate the
morphometric parameters of the odontoid process using 3-dimensional (3D)
reconstruction of computed tomography (CT) images and investigate the
applicability of using one or two screws for fixing odontoid process fractures.  

Methods: CT images of 100 patients (55 males, 45 females)
were transferred to the OsiriX program in DICOM format and converted into three
dimensional images using the 3D volume rendering feature. Male and female
groups were divided into 8–30, 31–50 and over 50 age groups and features of the
odontoid process were measured.  

Results: In the coronal plane, the minimum external
transverse length of the odontoid process (OPmin) was highest in males over 50
year of age with a value of 11.3 mm. In the sagittal plane, the combination of
anterior-posterior length of the odontoid process and vertebral body (OPAP) was
highest in the males over 50 (14.5 mm). The length of the line taken from the
anterior-inferior corner of the vertebral body to the top of odontoid process (LAIT)
was measured the highest measured as 45.2 mm in males over 50. These
measurements were higher in males than females.   

Conclusion: The results of this study showed that it is
possible to use a single 4.5 mm or 3.5 mm cannulated screw in the Turkish population.
The application of two 3.5 mm screws was found to be appropriate in 76% of
males and 62% of females.  

Anahtar Kelimeler

CT, 3-dimensional reconstruction method, odontoid process, axis, fracture

Kaynakça

• References
• 1. Şahinoğlu K. Kliniğe Yönelik Anatomi. Nobel Tıp Kitabevleri. 2014.
• 2. Moore, K. & Dalley II A. Clinically Oriented Anatomy. Lipincott Williams&Wilkins. 1999.
• 3. Arıncı, K. & Elhan A. Anatomi. Güneş Kitabevi. 2014.
• 4. Chir M. Fractures, dislocations, and fracture-dislocations of the spine. J Bone Jt Surg Am. 1970;52:1534–51.
• 5. Standring S, editor. Gray’s anatomy: the anatomical basis of clinical practice. 40th ed. 2008.
• 6. Gövsa Gökmen F. Sistematik Anatomi. Güven Kitabevi. İzmir; 2008.
• 7. Cramer GD. Clinical Anatomy of the Spine, Spinal Cord, and ANS. 3rd ed. G. D. Cramer ve D. A. Darby, editor. Elsevier Mosby; 2014. 135–209 p.
• 8. Korres DS. Fractures of the odontoid process. Springer; 2013. Chap 6, in The Axis Vertebra.
• 9. Akobo S, Rizk E, Loukas M, Chapman JR, Oskouian RJ, Tubbs RS. The odontoid process: a comprehensive review of its anatomy, embryology, and variations. Childs Nerv Syst [Internet]. 2015 Nov 8 [cited 2018 Sep 23];31(11):2025–34. Available from: http://link.springer.com/10.1007/s00381-015-2866-4.
• 10. Böhler J. Anterior stabilization for acute fractures and non-unions of the dens. J Bone Joint Surg Am [Internet]. 1982 Jan [cited 2018 Sep 23];64(1):18–27. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7033229.
• 11. Bednar DA, Parikh J, Hummel J. Management of type II odontoid process fractures in geriatric patients; a prospective study of sequential cohorts with attention to survivorship. J Spinal Disord [Internet]. 1995 Apr [cited 2018 Sep 23];8(2):166–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7606126.
• 12. Henry AD, Bohly J, Grosse A. Fixation of odontoid fractures by an anterior screw. J Bone Joint Surg Br [Internet]. 1999 May [cited 2018 Sep 23];81(3):472–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10872369.
• 13. Cloché T, Vital J-M. Chirurgie des traumatismes récents du rachis cervical. 2016 [cited 2018 Sep 23]; Available from: http://dx.doi.org/10.1016/S0246-0467.
• 14. Daher MT, Daher S, Nogueira-Barbosa MH, Defino HLA. Computed tomographic evaluation of odontoid process: implications for anterior screw fixation of odontoid fractures in an adult population. Eur Spine J [Internet]. 2011 Nov 21 [cited 2018 Sep 23];20(11):1908–14. Available from: http://link.springer.com/10.1007/s00586-011-1879-2.
• 15. Apfelbaum RI, Lonser RR, Veres R, Casey A. Direct anterior screw fixation for recent and remote odontoid fractures. J Neurosurg [Internet]. 2000 Oct [cited 2018 Sep 23];93(2 Suppl):227–36. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11012053.
• 16. Nucci RC, Seigal S, Merola AA, Group J, Mroczek KJ, Dryer J, et al. Computed tomographic evaluation of the normal adult odontoid. Implications for internal fixation. Spine (Phila Pa 1976) [Internet]. 1995 Feb 1 [cited 2018 Sep 23];20(3):264–70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7732463.
• 17. Yusof MI, Yusof AH, Abdullah MS, Hussin TMAR. Computed tomographic evaluation of the odontoid process for two-screw fixation in type-II fracture: a Malaysian perspective. J Orthop Surg (Hong Kong) [Internet]. 2007 Apr 4 [cited 2018 Sep 23];15(1):67–72. Available from: http://journals.sagepub.com/doi/10.1177/230949900701500115.
• 18. Schaffler MB, Alson MD, Heller JG, Garfin SR. Morphology of the dens. A quantitative study. Spine (Phila Pa 1976) [Internet]. 1992 Jul [cited 2018 Sep 23];17(7):738–43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1502635.
• 19. Korres DS, Lazaretos J, Papailiou J, Kyriakopoulos E, Chytas D, Efstathopoulos NE, et al. Morphometric analysis of the odontoid process: using computed tomography--in the Greek population. Eur J Orthop Surg Traumatol [Internet]. 2016 Feb 11 [cited 2018 Dec 26];26(2):119–25. Available from: http://link.springer.com/10.1007/s00590-015-1717-z.
• 20. Nakanishi T, Sasaki T, Takahata T, Aoki Y, Sueyasu M U, M, Washiya S IK. Internal fixation of the odontoid process. Orthop Surg Traumatol. 1980;23:399–406.
• 21. Doherty BJ, Heggeness MH, Esses SI. A biomechanical study of odontoid fractures and fracture fixation. Spine (Phila Pa 1976) [Internet]. 1993 Feb [cited 2018 Dec 26];18(2):178–84. Available from: http://www.ncbi.nlm.nih.gov/pubmed/844193122. Tun K, Kaptanoglu E, Cemil B, Yorubulut M, Karahan ST, Tekdemir I. Anatomical study of axis for odontoid screw thickness, length, and angle. Eur Spine J [Internet]. 2009 Feb [cited 2018 Dec 26];18(2):271–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19005694
• 22. Tun K, Kaptanoglu E, Cemil B, Yorubulut M, Karahan ST, Tekdemir I. Anatomical study of axis for odontoid screw thickness, length, and angle. Eur Spine J [Internet]. 2009 Feb [cited 2018 Dec 26];18(2):271–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19005694