Suphamungmee Worawit, Yurasakpong Laphatrada, Poonudom Kanchanaphan, Tubbs R Shane, Iwanaga Joe, Kruepunga Nutmethee, Chaiyamoon Arada, Suwannakhan Athikhun
Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand.
Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand.
Asian Spine J. 2023 Oct;17(5):975-984. doi: 10.31616/asj.2023.0030. Epub 2023 Aug 28.
This study consists of a retrospective cohort study, a systematic review, and a meta-analysis which were separately conducted. This study aimed to investigate the prevalence of atlas arch defects, generate an evidence-based synthesis, and propose a common classification system for the anterior and combined atlas arch defects. Atlas arch defects are well-corticated gaps in the anterior or posterior arch of the atlas. When both arches are involved, it is known as a combined arch defect. Awareness of these defects is essential for avoiding complications during surgical procedures on the upper spine. The prevalence of arch defects was investigated in an open-access OPC-Radiomics (Radiomic Biomarkers in Oropharyngeal Carcinoma) dataset comprising 606 head and neck computed tomography scans from oropharyngeal cancer patients. A systematic review and meta-analysis were performed to generate prevalence estimates of atlas arch defects and propose a classification system for the anterior and combined atlas arch defects. The posterior arch defect was found in 20 patients (3.3%) out of the 606 patients investigated. The anterior arch defect was not observed in any patient, while a combined arch defect was observed in one patient (0.2%). A meta-analysis of 13,539 participants from 14 studies, including the present study, yielded a pooled-posterior arch defect prevalence of 2.07% (95% confidence interval [CI], 1.22%-2.92%). The prevalences of anterior and combined arch defects were 0.00% (95% CI, 0.00%-0.10%) and 0.14% (95% CI, 0.04%-0.25%), respectively. The anterior and combined arch defects were classified into five subtypes based on their morphology and frequency. The present study showed that atlas arch defects were present in approximately 2% of the general population. For future studies, larger sample sizes should be used for studying arch defects to avoid the small-study effect and to predict the prevalence accurately.
本研究包括一项回顾性队列研究、一项系统评价和一项荟萃分析，这些研究是分别进行的。本研究旨在调查寰椎弓缺损的患病率，进行基于证据的综合分析，并提出一种针对寰椎前弓缺损和联合弓缺损的通用分类系统。寰椎弓缺损是寰椎前弓或后弓中皮质良好的间隙。当两个弓都受累时，称为联合弓缺损。了解这些缺损对于避免上颈椎手术过程中的并发症至关重要。在一个开放获取的OPC-放射组学（口咽癌中的放射组学生物标志物）数据集中调查了弓缺损的患病率，该数据集包含606例口咽癌患者的头颈部计算机断层扫描。进行了一项系统评价和荟萃分析，以得出寰椎弓缺损的患病率估计值，并提出一种针对寰椎前弓缺损和联合弓缺损的分类系统。在606例被调查患者中，发现20例（3.3%）存在后弓缺损。未在任何患者中观察到前弓缺损，而在1例患者（0.2%）中观察到联合弓缺损。对包括本研究在内的14项研究中的13539名参与者进行的荟萃分析得出，后弓缺损的合并患病率为2.07%（95%置信区间[CI]，1.22%-2.92%）。前弓缺损和联合弓缺损的患病率分别为0.00%（95%CI，0.00%-0.10%）和0.14%（95%CI，0.04%-0.25%）。根据前弓缺损和联合弓缺损的形态和发生频率将其分为五个亚型。本研究表明，一般人群中约2%存在寰椎弓缺损。对于未来的研究，应使用更大的样本量来研究弓缺损，以避免小研究效应并准确预测患病率。
