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J Bone Joint Surg Am. 2014 May 7;96(9):712-7. doi: 10.2106/JBJS.M.00814.

Association between advanced degenerative changes of the atlanto-dens joint and presence of dens fracture.

Author information

1
Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, OP 31, Portland, OR 97239. E-mail address for J.U. Yoo: yooj@ohsu.edu.

Abstract

BACKGROUND:

Dens fractures in elderly patients are often related to issues associated with aging. We examined the association between degenerative changes of the atlanto-dens joint and the risk of dens fracture.

METHODS:

We conducted a retrospective study of trauma patients, fifty-five years of age or older, who had undergone a computed tomography scan of the cervical spine as part of their admission to a single level-I trauma center. There were 1794 patients who met the inclusion criteria; scans were evaluated for all fifty-six who presented with a dens fracture and for a random sample of 736 without a dens fracture. Intraosseous cyst formation, synovitis, and joint space narrowing were recorded from the scans. The prevalence of degenerative changes was compared between patients with and patients without a dens fracture.

RESULTS:

An intraosseous cyst in the dens was found in 16.4% of the patients without a dens fracture and in 64.3% of those with a fracture (p < 0.001). The dens fracture extended through the existing cyst in twenty-four (66.7%) of thirty-six patients with a cyst and a dens fracture. Retro-dens synovitis was present in 4.2% of the patients without a dens fracture and 25.0% of those with a fracture (p < 0.001). After adjustment for age and sex, both cysts (odds ratio [OR] = 7.7, 95% confidence interval [CI] = 4.2 to 14.1) and synovitis (OR = 4.6, 95% CI = 2.1 to 10.0) were significantly associated with dens fracture.

CONCLUSIONS:

Intraosseous dens cysts and retro-dens synovitis were associated with dens fracture; those with a dens fracture were nearly eightfold more likely to have an intraosseous cyst and nearly fivefold more likely to have synovitis compared with those without a dens fracture. Because the atlanto-dens joint is a synovial joint, its degeneration can lead to subchondral cyst formation and synovitis and predispose affected individuals to fracture.

PMID:
24806007
DOI:
10.2106/JBJS.M.00814
[Indexed for MEDLINE]

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