Jenkins Skyler, Bordes Stephen, Aly Islam, Jeyamohan Shiveindra, Ishak Basem, Iwanaga Joe, Loukas Marios, Tubbs R Shane
Department of Anatomical Sciences, St. George's University, Grenada, West Indies.
Seattle Science Foundation, Seattle, Washington, USA.
World Neurosurg. 2019 Jul;127:e1120-e1126. doi: 10.1016/j.wneu.2019.04.052. Epub 2019 Apr 10.
Fracture of the odontoid process is a critical injury to diagnose and often treat. The aim of this anatomic study was to present a comprehensive understanding of this part of the C2 vertebra.
We used 20 C2 vertebrae. Samples underwent imaging (computed tomography [CT] with and without three-dimensional reconstruction, micro-CT, 1.5T magnetic resonance imaging) and sagittal and coronal sectioning using a bone saw. Sectioned specimens were imaged under a digital handheld microscope, and transillumination of the bone was used to highlight its internal trabecular pattern. Three samples underwent infusion of the odontoid process with a hardening substance and were then decalcified.
Internal trabecular patterns of the odontoid process of all specimens were discernible. In sagittal and coronal sections, trabecular patterns were highlighted with transillumination, but the patterns were much clearer using the digital microscope. Magnetic resonance imaging and CT provided the least detail of the imaging methods, but the trabecular patterns could be identified. Three-dimensional reconstruction of CT data was the preferred imaging method over magnetic resonance imaging and CT without three-dimensional reconstruction. The most distinct trabecular and cortical patterns were seen using micro-CT. Osteoporosis was seen in 2 specimens (10%). Five specimens (25%) were found to have a subdental synchondrosis. For most specimens, the trabeculae were found throughout the odontoid process.
Improved knowledge of the anatomy, structural composition, and variations within the C2 vertebra may allow for better treatment options and patient care.
齿突骨折是一种诊断和治疗都颇具挑战性的损伤。本解剖学研究的目的是全面了解第二颈椎的这一部分。
我们使用了20个第二颈椎。样本进行了成像（有和没有三维重建的计算机断层扫描[CT]、显微CT、1.5T磁共振成像），并使用骨锯进行矢状面和冠状面切片。切片后的标本在数字手持显微镜下成像，并利用骨的透照来突出其内部小梁模式。三个样本用硬化物质注入齿突，然后进行脱钙处理。
所有标本齿突的内部小梁模式均可辨别。在矢状面和冠状面切片中，小梁模式通过透照得以突出，但使用数字显微镜时模式更清晰。磁共振成像和CT提供的成像细节最少，但小梁模式可以识别。CT数据的三维重建是比磁共振成像和没有三维重建的CT更优选 的成像方法。使用显微CT观察到最明显的小梁和皮质模式。在2个标本（10%）中发现骨质疏松。5个标本（25%）发现有齿突下软骨结合。对于大多数标本，小梁遍布齿突。
对第二颈椎的解剖结构、组成及变异有更深入的了解，可能会带来更好的治疗选择和患者护理。
