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

STUDY DESIGN: Prospective study. PURPOSE: To assess the prevalence of periodontoid calcification and its associations with acute cervical pain. OVERVIEW OF LITERATURE: Calcium 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. METHODS: The 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. RESULTS: In 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. CONCLUSIONS: Our 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.

Acute neck pain caused by pseudogout attack of calcified cervical yellow ligament: a case report.

BACKGROUND: Calcification of the yellow ligament sometimes compresses the spinal cord and can induce myelopathy. Usually, the calcification does not induce acute neck pain. We report a case of a patient with acute neck pain caused by calcium pyrophosphate dihydrate in a calcified cervical yellow ligament. CASE PRESENTATION: A 70-year-old Japanese woman presented with acute neck pain. She had a moderately high fever (37.5 °C), and her neck pain was so severe that she could not move her neck in any direction. Computed tomography showed a high-density area between the C5 and C6 laminae suspicious for calcification of the yellow ligament. Magnetic resonance imaging showed intermediate-signal intensity on T1-weighted imaging and high-signal intensity on T2-weighted imaging surrounding a low-signal region on both T1- and T2-weighted imaging with cord compression. There was a turbid, yellow fluid collection in the yellow ligament at the time of operation. Histologically, calcium pyrophosphate dihydrate crystals were found in the fluid, and she was diagnosed as having a pseudogout attack of the yellow ligament. CONCLUSIONS: Pseudogout attack of the cervical yellow ligament is rare, but this clinical entity should be added to the differential diagnosis of acute neck pain, especially when calcification of the yellow ligament exists.

Acute neck pain caused by arthritis of the lateral atlantoaxial joint.

BACKGROUND CONTEXT: Many diseases can cause acute neck pain in elderly individuals. We conducted the present prospective study based on the hypothesis that arthritis of the lateral atlantoaxial joint may be involved in acute neck pain in elderly patients with limited neck rotation. PURPOSE: To clarify whether the lateral atlantoaxial joint is involved in acute neck pain among elderly individuals by conducting lateral atlantoaxial joint puncture. STUDY DESIGN: A prospective study. PATIENT SAMPLE: Twenty-seven patients (13 men, 14 women) aged 50 years or more who provided consent for atlantoaxial joint puncture met the following four inclusion criteria: acute neck pain with limited cervical rotation of less than 20° as the chief complaint; visual analog scale pain score of 70 mm or more at initial visit; tenderness in the paraspinal muscle of upper cervical vertebrae; and serum C-reactive protein level of 0.5 mg/dl or more. OUTCOME MEASURES: Visual analog scale pain score and radiologic findings. METHODS: Patients underwent puncture of the lateral atlantoaxial joint and were evaluated clinically and radiologically. RESULTS: Computed tomography obtained before puncture showed calcification of the transverse ligament of the atlas in the posterior dens in 22 patients (81.5%), calcification in the longus colli in 2 patients (7.4%), and no calcification in 3 patients (11.1%). Of 27 patients who underwent lateral atlantoaxial joint puncture, joint fluid was collected from 16 patients (59.3%) and calcium pyrophosphate dihydrate crystals were identified in 10 patients (62.5%). For the entire patient population, mean VAS score before puncture was 81.9±16.3 mm, significantly improving to 35.6±24.4 mm by 30 minutes after puncture (p<.001). CONCLUSIONS: The results of this study suggest that crystal-induced arthritis (pseudogout) of the lateral atlantoaxial joint may be closely involved with acute neck pain in the elderly.

Glenoid osteophyte and rotator cuff tears: an anatomic study.

The purpose of this study was to determine the morphologic characteristics of the glenoid osteophyte and its relationship to rotator cuff tears. Eighty-six cadaveric shoulders were studied. After inspection of cuff pathology, the glenoid was examined with soft x-rays. Histologically, degenerative changes of the articular cartilage and the labrum were assessed. There were 30 shoulders with rotator cuff tears (35%). Two types of glenoid osteophyte were identified: angular and hooked. Both osteophytes were commonly observed in the anterior to inferior portions of the glenoid. The length of hooked osteophytes was significantly greater in shoulders with full-thickness tears (2.7 +/- 2.2 mm [mean plus minus SD]) than in those with other cuff conditions (P =.0058). The hooked osteophyte was more commonly observed in shoulders with full-thickness tears (43%) and associated with degenerative changes of the cartilage and labrum. We conclude that the hooked osteophyte of the glenoid is characteristic in shoulders with full-thickness tears of the rotator cuff.