The prevalence of calcification around odontoid process and the incidence of crowned dens syndrome in the neurosurgical ward: A single institution’s analysis

A retrospective study of the prevalence of calcium deposits around the dens axis via cone beam computed tomography

OBJECTIVE

This study aimed to evaluate the relationship between the presence of calcium deposits (CDs) around the dens axis and patients' age, gender, and systemic diseases.

METHODS

This retrospective study was carried out by examining CBCT. Basic descriptive statistical analyses and normality tests were performed on all variables. The assumption of normality was checked using the Shapiro-Wilk method. The statistical significance level was accepted as a p-value less than 0.05.

RESULTS

CDs were observed in a total of 99 (21.9%) individuals. The incidence of CDs statistically significantly increased with age (p < .01),while it didn't statistically significantly differ between genders (p = .47). 13% were systemically healthy, while 55% had hypertension. The incidence of CDs was statistically significantly higher in individuals with hypertension.

CONCLUSIONS

In the presence of CDs, the patient should be referred to a medical doctor to confirm the diagnosis of CDS and prevent possible complications.

Crowned Dens Syndrome: A Challenging Diagnosis in Older Adults Presenting With Acute Neck Pain

Crowned dens syndrome (CDS) is a rare syndrome of calcium pyrophosphate dihydrate (CPPD) deposition on the odontoid process of the second cervical vertebra leading to unique clinical presentation and radiographical findings. Symptoms usually overlap with more common etiologies, including meningitis, stroke, and giant cell arteritis. Thus, patients struggle with extensive evaluation before diagnosing this uncommon condition. There are few case reports and case series of CDS in the literature. Patients respond well to treatment, but unfortunately, there is a high rate of relapse. Here we present an interesting case of a 78-year-old female patient who presented with acute onset headache and neck pain.

Case report: crowned dens syndrome in a patient with seronegative rheumatoid arthritis

Chondrocalcinosis (CC) is the one of the most common crystal pyrophosphate disease associated arthritis in the elderly. It has been shown to coexist with seronegative and seropositive rheumatoid arthritis (RA), yet mostly with seronegative RA. Among the localisation of CC, the deposition in the ligaments surrounding the odontoid process may remain asymptomatic for years or may lead to and acute severe symptomatology, which may mimic several clinical illnesses among which meningitis (fever, severe pain, acute phase reactants). This is called the 'crowned dens syndrome (CDS)', which has been reported to represent an important percentage of acute neck pain needing hospital admission in neurosurgery units. In this case, the rapid demonstration of 'crowned dens' through CT scan may allow to avoid lumbar puncture and cerebrospinal fluid examination. The coexistence of RA and CDS is very rare, and rarely reported in the literature, yet it may represent a clinical challenge. We describe here one case that while on therapy with methotrexate (MTX) and naproxen (NPX) had an acute neck pain, and peripheral arthritis flare, that responded well to colchicine given along with MTX and NPX.

Crowned Dens Syndrome: A Case Report and Literature Review

Crowned Dens Syndrome (CDS) is the leading cause of acute neck pain and a major cause of reduced neck mobility. The diagnosis of CDS is challenging as clinicians currently have limited awareness of the symptoms of the disease. In this article, we report a case of odontoid syndrome as a reference for the diagnosis and treatment of CDS.

Odontoid calcification and crowned dens syndrome: data from a Chinese center

OBJECTIVES

To assess the prevalence of calcification surrounding the odontoid process (odontoid calcification) with crowned dens syndrome (CDS) and without CDS (non-CDS) and investigate factors that may related to the onset of CDS.

METHODS

Retrospective review of consecutive patients visited Sir Run Run Shaw Hospital between 1 January 2018 and 5 November 2019 who were identified to have odontoid calcification on cervical computed tomography (CT) images. Those who presented with an acute or subacute episode of cervico-occipital pain were defined as CDS, others were non-CDS.

RESULTS

We diagnosed 69 cases of odontoid calcification among 2902 cervical CTs of 2556 patients (69/2556, 2.70%), 19 (19/2556, 0.74%) cases of which were CDS, 50 (50/2556, 1.96%) cases were non-CDS. Mean age was 71 (54-86) years old in odontoid calcification patients. The male-to-female ratio of patients with odontoid calcification was 27:42 (0.64). The prevalence of odontoid calcification was 69/1497 (6.14%) in individuals over 50 years old, The prevalence was 0.59% (4/679), 5.05% (26/515), 11.49% (27/235) and 20% (12/60) in patients aged 50-59, 60-69, 70-79 and 80-89 years old, respectively. Age and female gender were predictive factors of odontoid calcification. Lower hemoglobin (Hgb), red blood cell count (RBC), higher C-reactive protein (CRP), pain scale score were found in CDS patients comparing with non-CDS group. No difference of age, gender, hypertension, diabetes mellitus, smoking, alcohol history, creatinine, white blood cell count, mean corpuscular volume, uric acid, calcium was found between the two groups.

CONCLUSIONS

Odontoid calcification is a common radiological entity in patients older than 50 years. Lower Hgb, RBC, higher CRP, pain scale score were found in CDS patients comparing with non-CDS.

Síndrome de la apófisis odontoides coronada, una manifestación inusual de dolor cervical. Presentación de un caso

The calcium pyrophosphate dehydrate (CPPD) or hydroxyapatite (HA) crystal deposition disease can appear in any joint and the accumulation fo crystals in the cervical spine may be painful. Crowned dens syndrome is a rare clinical condition that involves crown-like calcification of the ligaments around the odontoid process. A 70-year-old man presented cervical pain, fever and a headache for over a week, therefore, a neurological condition was suspected. A CT scan revealed lentiform calcifications of the transverse ligament of the atlas. Steroid treatment and a non-steroidal anti-inflammatory diminished the symptoms. A proper clinical history and imaging studies avoid unnecessary procedures and makes it possible to include this entity as a differential diagnosis in acute cervical pain. Key words: Crystal deposition disease; acute cervical pain; crowned dens syndrome; Odontoid process

Crowned dens syndrome: a neurologist's perspective

Crowned dens syndrome is an under-recognized entity that can mimic neurological disease, in particular meningitis or giant-cell arteritis. We present a 48-year-old woman presenting with an inflammatory meningitis-like syndrome with headache and neck stiffness. Lumbar puncture was normal and computed tomography (CT) of the atlantoaxial joint showed abnormal calcifications around the odontoid process, leading to a tentative diagnosis of crowned dens syndrome. In addition, signs of active inflammation in and around the dens were present on cervical MR imaging. Since CDS can mimic meningitis or giant-cell arteritis, neurologists should be aware of this entity. If CDS is suspected, the bone window on the head CT scan can lead to the diagnosis. On the other hand, asymptomatic periodontoid calcifications are common and should not preclude further investigations.

Crowned dens syndrome, yet another rheumatic disease imposter

OBJECTIVE

Crowned dens syndrome (CDS) is defined as acute cervical or occipital pain due to a local inflammatory reaction related to calcifications in the ligaments surrounding the odontoid process. Virtually, all previous descriptions of CDS have related to calcium pyrophosphate dehydrate (CPPD) arthropathy.

METHODS

We prospectively identified a total of twenty-four consecutive inpatients with Crowned dens syndrome from January 2016 to December 2017 in our institution.

RESULTS

All patients (age range 54 to 87 years, 67% females) presented with acute onset pain in the upper neck and/or occiput accompanied with extreme neck stiffness. Most patients (79%) had elevated inflammatory markers. Four patients underwent temporal artery biopsy, which was negative for arteritis in all cases, and one was subjected to lumbar puncture, which was non-contributory. Seventeen patients (71%) had known rheumatic disease on presentation: 10 patients had the diagnosis of calcium pyrophosphate dehydrate arthropathy, 3 patients had ankylosing spondylitis, 2 patients had rheumatoid arthritis, 1 patient had Behcet's disease, and 1 suffered from Familial Mediterranean Fever. In 4 more patients, crowned dens syndrome was the presenting symptom of calcium pyrophosphate dehydrate disease. All patients were treated with glucocorticoids as 0.5 mg/kg prednisone plus colchicine 0.5 mg bid resulting in dramatic improvement in both clinical (head/neck pain alleviated and cervical spinal mobility regained) and laboratory measures.

CONCLUSIONS

Crowned dens syndrome should be considered, and craniocervical junction imaged in the context of acute cervical or occipital pain with stiffness and elevated inflammation markers not only in patients previously diagnosed with calcium pyrophosphate dehydrate arthropathy but also in diverse clinical settings.Key Points• This report highlights that crowned dens syndrome should be considered in various clinical setting besides calcium pyrophosphate dehydrate (CPPD) arthropathy.• Vigilance to this syndrome allows rapid treatment and may spare the patient unnecessary invasive procedures (i.e., temporal artery biopsy or lumbar puncture).

Elongated odontoid process in late Holocene skeletal remains from B6 archaeological site, Mendoza, Argentina

The odontoid process of the axis can be affected by congenital or acquired pathologies. While abnormalities such as os odontoideum, agenesis, and fractures are reported in archaeological remains, the abnormality of an elongated length of the odontoid process has not been described in the paleopathological literature. The aim of this paper is to evaluate two individuals with elongated odontoid processes from a skeletal assemblage from the B6 archaeological site (Mendoza, Argentina), and to discuss the possible etiologies of the condition, with particular attention given to the relation to trauma and Crowned Dens Syndrome (CDS), a condition characterized by the ossification of ligaments of the odontoid process of the second cervical vertebra.