• Juan A Sanchis-Gimeno, Susanna Llido, David Guede, Shahed Nalla, Francisco Martinez-Soriano, Esther Blanco-Perez, and Jose R Caeiro.
• Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Valencia, Spain. Electronic address: juan.sanchis@uv.es.
• World Neurosurg. 2018 Sep 1; 117: e162-e166.

BackgroundTo date, no information about the cortical bone microstructural properties in atlas vertebrae with arcuate foramen has been reported. As a result, we aimed to test in an experimental model if there is a cortical bone thickening in an atlas vertebra which has an arcuate foramen that may play a protective role against bone fracture.MethodsWe analyzed by means of micro-computed tomography the cortical bone thickness, the cortical volume, and the medullary volume (SkyScan 1172 Bruker micro-CT NV, Kontich, Belgium) in cadaveric dry atlas vertebrae with arcuate foramen and without arcuate foramen. We also reviewed a case series of 31 posterior atlas arch fractures to correlate the possible presence in the same atlas of both fracture and arcuate foramen.ResultsThe micro-computed tomography study revealed significant differences in cortical bone thickness (P < 0.001), cortical volume (P < 0.004), and medullary volume (P = 0.013) values between the arcuate foramen vertebrae and the nonarcuate foramen vertebrae. The clinical series found no coexistence in the same vertebra of a posterior atlas arch fractures and the arcuate foramen.ConclusionsAn atlas with arcuate foramen presents cortical bone thickening. This advantage in bone microarchitecture seems to contribute to a lower fracture risk compared to subjects without arcuate foramen as no coexistence in the same vertebra of a posterior atlas arch fractures and arcuate foramen was found.Copyright © 2018 Elsevier Inc. All rights reserved.

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