The borders of the odontoid process of C2 in adults and in children including the estimation of odontoid/body ratio

Abstract

The odontoid process of C2 projects upward from the superior roof of the body of C2. There is a confusion about the inferior border of the odontoid. The aims of this clinical study were to describe the inferior border of the odontoid process based on the remnant of dentocentral synchondrosis in adults, and the estimation of the odontoid/body ratio in pediatric and adult ages. Sixty-six cases were included for this study. Forty-four of them were in adult ages and the remaining 22 of them were in pediatric ages. The region of occiput, C1, C2, and C3, was examined with the magnetic resonance imaging (MRI) in all cases. The length of the odontoid process was estimated by using radiological images of MR from the tip of the odontoid to the remnant of dentocentral synchondrosis. The portion located under the level of synchondrosis was considered as the body of C2. The average length of the odontoid was 18. 6 mm in pediatric and 21. 3 mm in adult cases. In adult females, the length of the odontoid process (19. 1 mm in length) was smaller than those of adult males (23. 6 mm in length). The average ratio of odontoid/body was two in pediatric and 1.8 in adult cases. This study demonstrated that the neck of the odontoid segment at the level of superior articulating facets is not the synchondrosis between the odontoid process and the body of C2. The synchondrosis is located well below the level of superior articulating facets. It can be demonstrated with sagittal and coronal images of MR in both of pediatric and adult individuals.

Fig. 1

a Sagittal T1-weighted magnetic resonance imaging (MRI) in a 3 years old pediatric individual shows the tip, neck, and base of the odontoid process (T tip of the odontoid, N the neck of the odontoid, Ba the base of the odontoid, Bo the body of C2, one arrow shows dentocentral synchondrosis, double arrow shows apicodental synchondrosis). b. Coronal T1-weighted MRI of a pediatric case shows the segments of the odontoid process (T tip of the odontoid, N the neck of the odontoid, Ba the base of the odontoid, Bo the body of C2, one arrow shows dentocentral synchondrosis, double arrow shows apicodental synchondrosis). c Segmentation of an adult odontoid process in a direct X-ray (T tip of the odontoid, N the neck of the odontoid, Ba the base of the odontoid, Bo the body of C2)

Fig. 2

a Sagittal T1-weighted MRI in a 63 years old adult individual shows the tip, neck, and base of the odontoid process (T tip of the odontoid, N the neck of the odontoid, Ba the base of the odontoid, Bo the body of C2, arrow shows the remnant of the dentocentral synchondrosis). b Coronal T1-weighted MRI of an adult case shows the segments of the odontoid process (T tip of the odontoid, N the neck of the odontoid, Ba the base of the odontoid, Bo the body of C2, arrow shows the remnant of the dentocentral synchondrosis). c 3D reconstruction of C2 in the adult case shows the remnant of the dentocentral synchondrosis (T tip of the odontoid, N the neck of the odontoid, Ba the base of the odontoid, Bo the body of C2, arrow shows the remnant of the dentocentral synchondrosis)

Fig. 3

The segments of C2 were marked in a cadaveric bone (T tip of the odontoid, N the neck of the odontoid, Ba the base of the odontoid, Bo the body of C2, DCS dentocentral synchondrosis)

Fig. 4

The location of dentocentral synchondrosis was shown in a cadaveric bone (T tip of the odontoid, N the neck of the odontoid, Ba the base of the odontoid, Bo the body of C2, DCS dentocentral synchondrosis, arrows show the remnant of the dentocentral synchondrosis)