Out of 620 consecutive examinations of the atlanto-odontoid joint in patients referred for computed tomography (CT) of the brain or paranasal sinuses, gas collection within the atlanto-odontoid joint was observed in 12 (1.9%). Degenerative abnormalities at the atlanto-odontoid joint were significantly more frequent in patients with a gas-induced vacuum phenomenon than in an age-matched control group. The CT findings and association of the vacuum phenomenon with osteoarthritis of the atlanto-odontoid joint are discussed.