The development of the axis vertebra: the key to a topographic classification of dens fractures

Gebauer, Matthias; Amling, Michael

doi:10.1007/s00586-008-0809-4

Cited by 6 publications

(2 citation statements)

References 13 publications

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“…The dentate ossification center forms the neck and base of the dens while the tip of the odontoid process is formed by the apical center. 5,18 The ossification centers are separated by cartilaginous synchondroses; the neurocentral synchondroses are among the neural arches and C-2 body, and the dentocentral synchondrosis is between the dentate center and C-2 body. The synchondroses fuse at 3-6 years of age.…”

Section: Discussionmentioning

confidence: 99%

Estimation of odontoid process posterior inclination, odontoid height, and pB–C2 line in the adult population

Khaleel¹,

Besachio²,

Bisson

et al. 2014

SPI

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Object Posterior odontoid process inclination has been associated with Chiari malformation Type I in the pediatric population. There are varying reports to support a reliable range of odontoid inclination angles in control adults. The purpose of this study is to estimate the normal measurements in adults for odontoid retroflexion, retroversion, height, and the pB–C2 line (a line drawn through the odontoid tip from the ventral dura perpendicular to a second line from drawn the basion to the inferoposterior aspect of C-2 vertebral body) to establish a normative reference in this population. Methods After obtaining institutional review board approval, the authors performed a retrospective analysis of non–contrast enhanced cervical spine CT scans obtained in 150 consecutive control adults. Three neuroradiologists measured odontoid retroflexion, odontoid retroversion, odontoid height, and the pB–C2 line. The cohort was divided into sex and two age groups. Comparisons of the means with unpaired 2-tailed t-test were performed. Results A total of 125 subjects met the inclusion criteria; 80 were men and 45 were women (mean age 52 years, range 18–89 years). The odontoid retroflexion angle ranged from 70° to 89° (mean 79.3° ± 4.9°), and the odontoid retroversion angle ranged from 57° to 87° (mean 71.9° ± 5.3°). The range and mean of odontoid height were 17–27 mm and 22 ± 1.8 mm, respectively. The mean pB–C2 line was 6.5 ± 2.1 mm with a range of 0–11.2 mm. The results were also compared with previously published pediatric data. Conclusions The current study demonstrates that the odontoid process in adults is anatomically different from that in children: it is longer, more posteriorly inclined, and has a greater pB–C2 line. Therefore, utilization of these parameters with previously published cutoffs in the pediatric population is not appropriate for surgical planning in adults.

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Section: Discussionmentioning

confidence: 99%

Estimation of odontoid process posterior inclination, odontoid height, and pB–C2 line in the adult population

Khaleel¹,

Besachio²,

Bisson

et al. 2014

SPI

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“…Gross and Benzel have postulated that the cervico-cranium and the subaxial spine are embryologically separated at the isthmus of the C2 vertebra making it vulnerable to injury [3]. This developmental model has been supported by Gebauer and Amling [39]. They also use the C3 body chip fracture at the antero-rostral body and the kyphosis of the C2–3 junction as the indicators for the flexion injuries.…”

Section: Clinical Relevance To Hangman’s Injuries Of the Cervical Spinementioning

confidence: 99%

Mechanically Relevant Anatomy of the Axis Vertebra and Its Relation to Hangman’s Fracture: An Illustrated Essay

Menon

2019

Neurospine

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To describe the biomechanically relevant anatomy of the Axis vertebra and the load transfer patterns within the bone, and on that basis, to postulate its mechanism of injury, a literature review was conducted of the anatomy and biomechanics of Axis fractures. Two hypotheses have been presented: the internal gear hypothesis and the leaf spring hypothesis. Both are based on the trabecular anatomy of the vertebra and its load transmission patterns. The relationship of the Axis with Hangman’s injury is also discussed. According to the leaf spring hypothesis, the C2 pedicle corresponds to the shackle in the assembly and constitutes the weak link. The trabecular architecture of the Axis is such that the primary compression of the trabeculae is directed from the superior facet to the C2–3 endplate, with few trabeculae directed to the inferior facet. Along with the trabecular void in this area, this renders the isthmus vulnerable to trauma. The isthmus of the Axis is biomechanically susceptible to injury due to its unique anatomy in relation to the whole cervical spine and the internal load transmission patterns of the bone. The author suggests that in the flexion type of Hangman’s injury, the C1–2 posterior ligaments are disrupted and need to be addressed.

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The Axis Vertebra

Korres¹

2013

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The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

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The development of the axis vertebra: the key to a topographic classification of dens fractures

Cited by 6 publications

References 13 publications

Estimation of odontoid process posterior inclination, odontoid height, and pB–C2 line in the adult population

Estimation of odontoid process posterior inclination, odontoid height, and pB–C2 line in the adult population

Mechanically Relevant Anatomy of the Axis Vertebra and Its Relation to Hangman’s Fracture: An Illustrated Essay

The Axis Vertebra

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