Utility of Hounsfield units in predicting fusion rates of patients undergoing anterior odontoid screw fixation following Anderson d'Alonzo type II and shallow type III fractures

Lodin, Jan; Hejčl, Aleš; Bolcha, Martin; Sameš, Martin; Vachata, Petr

doi:10.23736/s0390-5616.20.05190-5

Cited by 2 publications

(2 citation statements)

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“…A similar decrease in transitional bone density was also described in this study. It should be noted that this study involved patients who had already sustained a dens axis fracture and not healthy patients [ 32 ]. In comparison, only patients without a fracture were examined in our study.…”

Section: Discussionmentioning

confidence: 99%

Bone density of the axis (C2) measured using Hounsfield units of computed tomography

et al. 2023

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Introduction The assessment of bone density is of great importance nowadays due to the increasing age of patients. Especially in regard to the surgical stabilization of the spine, the assessment of bone density is important for therapeutic decision making. The aim of this work was to record trabecular bone density values using Hounsfield units of the second cervical vertebra. Material and methods The study is a monocentric retrospective data analysis of 198 patients who received contrast-enhanced polytrauma computed tomography in a period of two years at a maximum care hospital. Hounsfield units were measured in three different regions within the C2: dens, transition area between dens and vertebral body and vertebral body. The measured Hounsfield units were converted into bone density values using a validated formula. Results A total of 198 patients were included. The median bone density varied in different regions of all measured C2 vertebrae: in the dens axis, C2 transition area between dens and vertebral body, and in the vertebral body bone densities were 302.79 mg/cm3, 160.08 mg/cm3, and 240.31 mg/cm3, respectively. The transition area from dens axis to corpus had statistically significant lower bone density values compared to the other regions (p < 0.001). There was a decrease in bone density values after age 50 years in both men and women (p < 0.001). Conclusions The transitional area from dens axis to corpus showed statistically significant lower bone density values compared to the adjacent regions (p < 0.001). This area seems to be a predilection site for fractures of the 2nd cervical vertebra, which is why special attention should be paid here in radiological diagnostics after a trauma.

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Section: Discussionmentioning

confidence: 99%

Bone density of the axis (C2) measured using Hounsfield units of computed tomography

et al. 2023

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“…It seems that the same Y-shape TBS, that appears to be crucial for physiological and biomechanical function of the C1-2 joint, 13 is itself a cause of non-fusion even in the case of anterior odontoid screwing treatment. Indeed, Lodin et al 32 , reporting the preoperative Hounsfield units (HU) values measured in three areas of the axis and indirectly showing the presence a TBS in the axis, seems to predict the probability of successful fusion in patients undergoing anterior odontoid screwing for type II C2 fractures. This internal nonuniform distribution of trabecular bone within the dens of the axis may affect the internal fixation of this bone in case of fracture and suggests that fixation devices inserted through this area may obtain relatively poor purchase and may be prone to cut-through failure.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

The internal trabecular bone structure of the odontoid process of the axis. A retrospective single-center comparative study in patients following cervical trauma.

Montemurro

Cocciaro

Liberti

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Background Odontoid C2 fractures account for 9% to 15% of adult cervical spine fractures. The aim of this study is to report the incidence of a previous described Y-shaped trabecular bone structure (TBS) in the odontoid process in a larger sample of patients who performed a CT cervical scan following a cervical trauma to investigate if its absence can increase the risk of the odontoid process fracture of the axis. Methods A retrospective review of 245 patients who performed a CT cervical scan in our University Hospital, as results of cervical spine injury, was performed during a 12-month period between May 2020 and May 2021. Results The presence of a Y-shaped TBS at the odontocentral synchondrosis level was observed in 165 patients that is 67.3% of whole population included in this study. Eighteen patients (7.3%) reported an odontoid type II C2 fracture. Among patients with odontoid type II C2 fracture, the Y-shaped TBS at the odontocentral synchondrosis level was observed in 8 (44.4%) of them. The presence of the Y-shaped TBS at the odontocentral synchondrosis level was statistically more frequently observed in patients without odontoid process fracture (69.2% Vs 30.8%) compared to patients who developed odontoid process fracture (44.4 % Vs 55.6%) after a cervical trauma (p = 0.03). Conclusions This study showed the crucial role of this Y-shaped TBS in biomechanical structural dynamics of the C1-C2 joint and its significant clinical relevance in odontoid fractures of the axis.

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Utility of Hounsfield units in predicting fusion rates of patients undergoing anterior odontoid screw fixation following Anderson d'Alonzo type II and shallow type III fractures

Cited by 2 publications

References 30 publications

Bone density of the axis (C2) measured using Hounsfield units of computed tomography

Bone density of the axis (C2) measured using Hounsfield units of computed tomography

The internal trabecular bone structure of the odontoid process of the axis. A retrospective single-center comparative study in patients following cervical trauma.

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