Evaluation of Odontoid Process Bone Quality with Hounsfield Unit Values in the Adult Population

Year 2024, Volume: 77 Issue: 3, 248 - 252, 10.10.2024

Baran Can Alpergin , Murat Zaimoğlu , Ömer Mert Özpişkin , Eyüp Bayatlı Yusuf Şükrü Çağlar , Ümit Eroğlu

Abstract

Objectives: In this study, the aim is to investigate the changes in bone density and quality of the odontoid tip, neck and second cervical vertebral
body located beneath the base of odontoid with advancing age.

Materials and Methods: Seven study groups were formed, each consisting of healthy individuals in the age ranges of 18-29, 30-39, 40-49, 50-59,
60-69, 70-79, and 80 years and above. The odontoid bone structure of each individual was identified on cervical computed tomography images in
both sagittal and coronal planes. Mean Hounsfield unit (HU) values were calculated for the odontoid tip, odontoid neck, and the C2 body portion
below the odontoid base areas in both midsagittal and midcoronal planes. The HU values were compared and analyzed.

Results: There is a significant, negative correlation between age and the HU values measured in the sagittal plane for the odontoid tip, odontoid
neck, and C2 vertebral body portion under the odontoid base (the correlation coefficients are -0.795 r, -0.766 r, and -0.789 r, respectively). Similarly,
there is a significant, negative correlation between age and the HU values measured in the coronal plane for the odontoid tip, odontoid neck, and C2
vertebral body portion under the odontoid base (the correlation coefficients are -0.836 r, -0.680 r, and -0.802 r, respectively). These results indicate
that as age increases, the quality of the odontoid bone decreases.

Conclusion: The assessment of bone quality through computed tomography, based on HU values, reveals a significant decrease in the bone quality
of both the odontoid bone and C2 vertebral body with increasing age.

Keywords

Odontoid bone , odontoid fractures , Hounsfield unit

Ethical Statement

This retrospective study was approved by Ankara University Human Research Ethics Committee

Supporting Institution

-

Project Number

-

Thanks

-

Erişkin Popülasyonda Hounsfield Ünitesi Değerleri ile Odontoid Proses Kemik Kalitesinin Değerlendirilmesi

Abstract

Amaç: İlerleyen yaş ile birlikte odontoid proses fraktürlerindeki artışın kemik kalitesinin zaman içinde azalması ile ilişkili olabileceği gösterilmektedir.
Bu çalışmada, ilerleyen yaşla birlikte odontoid proses, boyun ve ikinci servikal vertebra gövdesindeki kemik yoğunluğu ve kalitesindeki değişikliklerin
araştırılması amaçlanmıştır.

Gereç ve Yöntem: Her biri 18-29, 30-39, 40-49, 50-59, 60-69, 70-79 ve 80 yaş ve üzeri sağlıklı bireylerden oluşan yedi çalışma grubu oluşturuldu.
Her bireyin odontoid kemik yapısı bilgisayarlı tomografi görüntülerinde tanımlandı. Ortalama Hounsfield ünitesi (HU) değerleri odontoid proses,
odontoid boynu ve C2 gövde kısmı için hem midsagittal hem de midkoronal planlarda hesaplandı. Elde edilen veriler söz konusu 7 grup arasında
karşılaştırıldı ve istatistiksel olarak analiz edildi.

Bulgular: Yaş ile odontoid proses, odontoid boynu ve C2 vertebra gövdesi kısmı için sagital düzlemde ölçülen HU değerleri arasında anlamlı, negatif
bir korelasyon vardı (korelasyon katsayıları sırasıyla -0,795 r, -0,766 r ve -0,789 r’dir). Benzer şekilde, yaş ile odontoid ucu, odontoid boynu ve
odontoid tabanının altındaki C2 vertebra gövdesi kısmı için koronal düzlemde ölçülen HU değerleri arasında anlamlı, negatif bir korelasyon vardı
(korelasyon katsayıları sırasıyla -0,836 r, -0,680 r ve -0,802 r’dir). Bu sonuçlar, yaş arttıkça odontoid kemiğin kalitesinin azaldığını göstermektedir.

Sonuç: HU değerlerine dayalı olarak bilgisayarlı tomografi ile kemik kalitesinin değerlendirilmesi, artan yaşla birlikte hem odontoid kemiğin hem de
C2 vertebra gövdesinin kemik kalitesinde önemli bir düşüş olduğunu ortaya koymaktadır.

Keywords

Odontoid kemik , odontoid kırıklar , Hounsfield ünitesi

Ethical Statement

-

Supporting Institution

-

Project Number

-

Thanks

-

References

• 1. Akobo S, Rizk E, Loukas M, et al. The odontoid process: a comprehensive review of its anatomy, embryology, and variations. Childs Nerv Syst. 2015;31:2025-2034. 2. Tubbs RS, Hallock JD, Radcliff V, et al. Ligaments of the craniocervical junction. J Neurosurg Spine. 2011;14:697-709.
• 3. Lacy J, Bajaj J, Gillis CC. Atlantoaxial Instability. Treasure Island (FL): StatPearls Publishing. 2023.
• 4. Carvalho AD, Figueiredo J, Schroeder GD, et al. Odontoid Fractures: A Critical Review of Current Management and Future Directions. Clin Spine Surg. 2019;32:313-323.
• 5. Ryan MD, Taylor TK. Odontoid fractures in the elderly. J Spinal Disord. 1993;6:397-401
• 6. Denaro V, Papalia R, Di Martino A, et al. The best surgical treatment for type II fractures of the dens is still controversial. Clin Orthop Relat Res. 2011;469:742-750.
• 7. Shears E, Armitstead CP. Surgical versus conservative management for odontoid fractures. Cochrane Database Syst Rev. 2008;2008:CD005078.8. Simion G, Eckardt N, Senft C, et al. Bone density of the axis (C2) measured using Hounsfield units of computed tomography. J Orthop Surg Res. 2023;18:93.
• 9. Hans D, Fuerst T, Lang T, et al. How can we measure bone quality? Baillieres Clin Rheumatol. 1997;11:495-515.
• 10. Mertens R, Hecht N, Bauknecht HC, et al. The Use of Intraoperative CT Hounsfield Unit Values for the Assessment of Bone Quality in Patients Undergoing Lumbar Interbody Fusion. Global Spine J. 2023;13:2218-2227.
• 11. Iyer S, Hurlbert RJ, Albert TJ. Management of Odontoid Fractures in the Elderly: A Review of the Literature and an Evidence-Based Treatment Algorithm. Neurosurgery. 2018;82:419-430.
• 12. Chaudhary A, Drew B, Orr RD, et al. Management of type II odontoid fractures in the geriatric population: outcome of treatment in a rigid cervical orthosis. J Spinal Disord Tech. 2010;23:317-320.
• 13. Wagner SC, Schroeder GD, Kepler CK, et al. Controversies in the Management of Geriatric Odontoid Fractures. J Orthop Trauma. 2017;31(Suppl 4):44-48.
• 14. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312:1254-1259.
• 15. Schreiber JJ, Anderson PA, Rosas HG, et al. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011;93:1057-1063
• 16. Zhou LP, Shang J, Zhang ZG, et al. Characteristics and Comparisons of Morphometric Measurements and Computed Tomography Hounsfield Unit Values of C2 Laminae for Translaminar Screw Placement Between Patients With and Without Basilar Invagination. Neurospine. 2022;19:899-911.
• 17. No authors listed. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1-129.
• 18. Johnson CC, Gausden EB, Weiland AJ, et al. Using Hounsfield Units to Assess Osteoporotic Status on Wrist Computed Tomography Scans: Comparison With Dual Energy X-Ray Absorptiometry. J Hand Surg Am. 2016;41:767- 774.
• 19. Lenz M, Egenolf P, Weber M, et al. Pedicle or lateral mass screws in Goel- Harms construct? A biomechanical analysis. Injury. 2023.
• 20. Naderi S, Arman C, Güvençer M, et al. Morphometric analysis of the C2 body and the odontoid process. Turk Neurosurg. 2006;16:14-18.
• 21. Verbeek BM, Janssen SJ, Pielkenrood BJ, et al. Quantitative 3-dimensional Computed Tomography (Q3DCT) analysis of odontoid fractures. J Clin Neurosci. 2020;71:164-169.
• 22. Keller S, Bieck K, Karul M, et al. Lateralized Odontoid in Plain Film Radiography: Sign of Fractures? A Comparison Study with MDCT. Rofo. 2015;187:801-807.
• 23. Benca E, Zderic I, van Knegsel KP, et al. Biomechanical assessment of fracture loads and patterns of the odontoid process. Spine. 2022;47:1212- 1220.