Prevalence of degenerative changes of the atlanto-axial joints.
BACKGROUND CONTEXT
Degeneration of the atlantodens and atlanto-axial joints is associated with cervical spine pain and may also be associated with an increased risk of dens fracture. However, there is paucity of literature describing the prevalence of specific degenerative changes in the atlantodens and atlanto-axial facet joints.


PURPOSE
To document age-related degenerative changes of the cervical spine in a large cohort of patients.


STUDY DESIGN/SETTING
This is a retrospective cohort study.


PATIENT SAMPLE
Adult trauma patients were admitted to our Level 1 trauma center.


OUTCOME MEASURES
Osteoarthritis of the atlantodens and atlanto-axial facet joints of the cervical spine and the presence of intraosseous cyst and calcific synovitis, as determined by computed tomography (CT) scans.


METHODS
We conducted a retrospective study of 1,543 adult trauma patients who received a cervical spine CT scan. The anterior atlantodens joint interval was measured. The presence or absence of intraosseous cysts and calcific synovitis was recorded. Degeneration of the atlantodens and atlanto-axial facet joints at age intervals was quantified.


RESULTS
The atlantodens interval narrowed linearly with age (R(2)=0.992, p<.001). The prevalence of intraosseous cysts increased exponentially with age from 4.2% to 37.4%, and calcific synovitis increased from 0% to 11.1%. Intraosseous cyst formation generally began in the second and third decades of life and synovitis in the fifth and sixth decades of life. Facet joints also demonstrated age-related changes; however, the rate of degenerative changes was lower than in the atlantodens joint.


CONCLUSIONS
To our knowledge, this is the first study that documents specific changes of both atlantodens and atlanto-axial facet joints as a function of age in a large cohort of 1,543 patients. These changes increased exponentially with age and may contribute to pain and limitation in motion. In light of our findings and recent studies demonstrating the association between degeneration and dens fracture in elderly, cervical spine radiographs of elderly patients should be carefully assessed for these changes.
['Betsch|Marcel W|MW|', 'Blizzard|Sabina R|SR|', 'Shinseki|Matthew S|MS|', 'Yoo|Jung U|JU|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000375:Aging D001268:Atlanto-Axial Joint D002574:Cervical Vertebrae D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D019547:Neck Pain D010003:Osteoarthritis D015995:Prevalence D011859:Radiography D012189:Retrospective Studies D013585:Synovitis D055815:Young Adult D021801:Zygapophyseal Joint
Cervical spine Dens fracture Osteoarthritis Intraosseous cyst Calcific synovitis Risk factors