• Skyler Jenkins, Stephen Bordes, Islam Aly, Shiveindra Jeyamohan, Basem Ishak, Joe Iwanaga, Marios Loukas, and R Shane Tubbs.
• Department of Anatomical Sciences, St. George's University, Grenada, West Indies.
• World Neurosurg. 2019 Jul 1; 127: e1120-e1126.

ObjectiveFracture of the odontoid process is a critical injury to diagnose and often treat. The aim of this anatomic study was to present a comprehensive understanding of this part of the C2 vertebra.MethodsWe used 20 C2 vertebrae. Samples underwent imaging (computed tomography [CT] with and without three-dimensional reconstruction, micro-CT, 1.5T magnetic resonance imaging) and sagittal and coronal sectioning using a bone saw. Sectioned specimens were imaged under a digital handheld microscope, and transillumination of the bone was used to highlight its internal trabecular pattern. Three samples underwent infusion of the odontoid process with a hardening substance and were then decalcified.ResultsInternal trabecular patterns of the odontoid process of all specimens were discernible. In sagittal and coronal sections, trabecular patterns were highlighted with transillumination, but the patterns were much clearer using the digital microscope. Magnetic resonance imaging and CT provided the least detail of the imaging methods, but the trabecular patterns could be identified. Three-dimensional reconstruction of CT data was the preferred imaging method over magnetic resonance imaging and CT without three-dimensional reconstruction. The most distinct trabecular and cortical patterns were seen using micro-CT. Osteoporosis was seen in 2 specimens (10%). Five specimens (25%) were found to have a subdental synchondrosis. For most specimens, the trabeculae were found throughout the odontoid process.ConclusionsImproved knowledge of the anatomy, structural composition, and variations within the C2 vertebra may allow for better treatment options and patient care.Copyright © 2019 Elsevier Inc. All rights reserved.

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