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