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Regional variations in C1-C2 bone density on quantitated computed tomography and clinical implications.

Jamie L Baisden1, Vicky Varghese2, Anjishnu Banerjee3

  • 1Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, United States.

North American Spine Society Journal
|July 13, 2023
PubMed
Summary

Elderly spine fractures show regional bone density differences in C1 and C2 vertebrae. Understanding these variations, particularly lower bone mineral density in C1 lateral masses, is crucial for effective surgical stabilization techniques in older adults.

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Area of Science:

  • Orthopedics
  • Geriatric Medicine
  • Anatomy

Background:

  • The elderly population is growing, leading to an increase in upper cervical spine fractures (C1 and C2).
  • Elderly patients are often poor surgical candidates, and nonoperative management of these fractures has high nonunion rates.
  • Bone quality in the elderly is inferior, potentially altering optimal surgical stabilization techniques compared to younger populations.

Purpose of the Study:

  • To determine regional variations in bone mineral density (BMD) at the C1 and C2 vertebrae in an elderly population.
  • To investigate potential gender differences in regional BMD at C1 and C2.

Main Methods:

  • Quantitative computed tomography (QCT) was used to measure BMD in 20 cadaveric spines (ages 45-83).
  • BMD was assessed in 8 specific regions of C1 and 7 specific regions of C2.
  • Regional BMD measurements were analyzed for variations and potential gender differences.

Main Results:

  • Bone mineral density (BMD) was highest at the C1 anterior tubercle and posterior arch, and lowest at the C1 lateral masses.
  • At C2, BMD was highest at the top of the dens and decreased towards the mid-body.
  • The C1 posterior arch and C2 spinous process showed higher BMDs, with a strong correlation between dens-vertebral body and vertebral body BMD.

Conclusions:

  • Regional BMD variations in C1 and C2 vertebrae have significant clinical implications for surgical stabilization in the elderly.
  • Higher BMD in the C1/C2 posterior elements suggests these areas may be suitable for certain fixation techniques, like wiring.
  • Lower BMD in C1 lateral masses may increase the risk of screw loosening and nonunion, favoring consideration of traditional wiring techniques in the elderly.