Asian Spine J.
2023 Oct;17(5):975-984. 10.31616/asj.2023.0030.
Radiological Study of Atlas Arch Defects with Meta-Analysis and a Proposed New Classification
- Suphamungmee W
1 - Yurasakpong L1,2,3
- Poonudom K1,3,4
- Tubbs RS5,6,7,8,9
- Iwanaga J5,6,10,11
- Kruepunga N1,3
- Chaiyamoon A2
- Suwannakhan A1,3
- Affiliations
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- 1Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
- 2Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
- 3In Silico and Clinical Anatomy Research Group (iSCAN), Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
- 4Vejnitatphattana School, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- 5Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
- 6Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
- 7University of Queensland, Brisbane, Australia
- 8Department of Neurosurgery and Ochsner Neurosciences Institute, Ochsner Health System, New Orleans, LA, USA
- 9Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada
- 10Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA
- 11Department of Anatomy, Kurume University School of Medicine, Fukuoka, Japan
- 12Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- KMID: 2547594
- DOI: http://doi.org/10.31616/asj.2023.0030
Abstract
- This study consists of a retrospective cohort study, a systematic review, and a meta-analysis which were separately conducted. This study aimed to investigate the prevalence of atlas arch defects, generate an evidence-based synthesis, and propose a common classification system for the anterior and combined atlas arch defects. Atlas arch defects are well-corticated gaps in the anterior or posterior arch of the atlas. When both arches are involved, it is known as a combined arch defect. Awareness of these defects is essential for avoiding complications during surgical procedures on the upper spine. The prevalence of arch defects was investigated in an open-access OPC-Radiomics (Radiomic Biomarkers in Oropharyngeal Carcinoma) dataset comprising 606 head and neck computed tomography scans from oropharyngeal cancer patients. A systematic review and meta-analysis were performed to generate prevalence estimates of atlas arch defects and propose a classification system for the anterior and combined atlas arch defects. The posterior arch defect was found in 20 patients (3.3%) out of the 606 patients investigated. The anterior arch defect was not observed in any patient, while a combined arch defect was observed in one patient (0.2%). A meta-analysis of 13,539 participants from 14 studies, including the present study, yielded a pooled-posterior arch defect prevalence of 2.07% (95% confidence interval [CI], 1.22%–2.92%). The prevalences of anterior and combined arch defects were 0.00% (95% CI, 0.00%–0.10%) and 0.14% (95% CI, 0.04%–0.25%), respectively. The anterior and combined arch defects were classified into five subtypes based on their morphology and frequency. The present study showed that atlas arch defects were present in approximately 2% of the general population. For future studies, larger sample sizes should be used for studying arch defects to avoid the small-study effect and to predict the prevalence accurately.
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