Age-Related Prevalence of Periodontoid Calcification and Its Associations with Acute Cervical Pain

Abstract

Study DesignProspective study.PurposeTo assess the prevalence of periodontoid calcification and its associations with acute cervical pain.Overview of LiteratureCalcium pyrophosphate dihydrate (CPPD) deposition disease is a common rheumatological disorder that occurs especially in elderly patients. Although CPPD crystals induce acute arthritis, these crystals are not usually symptomatic. Calcification surrounding the odontoid process (periodontoid calcification) has been reported to induce inflammation, resulting in acute neck pain. This disease is called crowned dens syndrome. Whether calcification induces inflammation or whether the crystals are symptomatic remains unclear.MethodsThe prevalence of periodontoid calcification at the atlas transverse ligament was examined by computed tomography of the upper cervical spine in patients suspected of brain disease but no cervical pain (control group, n=296), patients with pseudogout of the peripheral joints but no cervical pain (arthritis group, n=41), and patients with acute neck pain (neck pain group, n=22). Next, the correlation between the prevalence of periodontoid calcification and symptoms was analyzed.ResultsIn the control group, 40 patients (13.5%) showed periodontoid calcification with no significant difference in the prevalence with gender. The prevalence of calcification increased significantly with age (p=0.002). In the arthritis group, 26 patients (63.4%) reported periodontoid calcification. In the neck pain group, 14 patients (63.6%) reported periodontoid calcification. Multiple logistic regression analysis by age and group revealed that higher age, inclusion in the arthritis group, and inclusion in the neck pain group significantly affected the prevalence of calcification.ConclusionsOur results cumulatively suggest that periodontoid calcification is an aging-related reaction and that calcification per se does not always cause neck pain. Periodontoid calcification was observed more frequently in patients with pseudogout of the peripheral joints and in those with acute neck pain than in asymptomatic control patients.

What a pain in the neck: Crowned dens syndrome as an uncommon cause of neck pain

“…Plain film X-rays are usually adequate for diagnosis of peripheral calcium pyrophosphate deposition, but the overlap of structures within the caudal cervical spine area makes CT imaging focused on C1/C2 the gold standard of diagnosis [5]. Patients with CPPD calcification in peripheral joints have a higher prevalence of periodontoid calcification than the general population [7]. While this patient had no known history of pseudogout, plain films of her knee and hand showed findings consistent with CPPD.…”

A Case of Acute Neck Pain: The Crowned Dens Syndrome

“…This causes acute moderate to severe neck pain/stiffness worst at the base of the occiput and fever with raised inflammatory markers (ESR and C-reactive protein) [ 9 - 12 ]. It most commonly occurs in patients aged 60 years and above who may have other manifestations of CPPD deposition disease, including polyarticular arthritis with or without acute attacks of pseudogout affecting the knee, shoulder or wrist joints [ 13 - 15 ].…”

Fever of Unknown Origin with Fluorodeoxyglucose-crowned Dens Syndrome on Positron Emission Tomography: Case Reports

“…7 Corresponding prevalences of 15% and 24% have been reported in Japanese patients. 8 The prevalence of "concomitant" periodontoid calcifications with or without neck symptoms in CPPD patients has been reported as 51% to 63%. 4,6,8 These prevalence data in non-CPPD and CPPD patients highlight the importance of other criteria such as pyrexia or inflammatory markers in making a diagnosis of CDS, especially in the elderly people.…”