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J Neurol Sci. 2017 May 15;376:52-59. doi: 10.1016/j.jns.2017.02.050. Epub 2017 Feb 27.

Clinical and quantitative analysis of patients with crowned dens syndrome.

Author information

1
Department of Neurology, Seiwa Clinic, Tokyo, Japan. Electronic address: nrd27501@nifty.com.
2
Department of Neurology, Nagaoka-Nishi Hospital, Nagaoka, Japan; Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
3
Department of Neurology, Seiwa Clinic, Tokyo, Japan; Department of Neurology, Nagaoka-Nishi Hospital, Nagaoka, Japan; Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
4
Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.

Abstract

BACKGROUND:

Crowned dens syndrome (CDS) is a radioclinical entity defined by calcium deposition on the transverse ligament of atlas (TLA). In this study, the novel semi-quantitative diagnostic criteria for CDS to evaluate the degree of calcification on TLA by cervical CT are proposed.

METHOD:

From January 2010 to September 2014, 35 patients who were diagnosed with CDS by cervical CT were adopted as subjects in this study. Based on novel criteria, calcium deposition on TLA was classified into "Stage" and "Grade", to make a score, which was evaluated semi-quantitatively. The correlation between calcification score and CRP level or pain score, and the effects of treatments, such as NSAIDs and corticosteroids, were statistically analyzed.

RESULTS:

The total calcification score from added "Stage" and "Grade" scores demonstrated a significantly strong and linear correlation with CRP level (R2=0.823, **p<0.01). In the multiple comparison test for the treatment effects, significant improvement of the CRP level and pain score were demonstrated after corticosteroid therapy (**p<0.01) compared with NSAIDs. In the conditional logistic regression analysis, the rapid end of corticosteroid therapy was an independent risk factor for relapse of cervico-occipital pain [OR=50.761, *p=0.0419].

CONCLUSION:

The degree of calcification on TLA evaluated by the novel semi-quantitative criteria significantly correlated with CRP level. In the treatment of CDS, it is recommended that a low dosage (15-30mg) of corticosteroids be used as first-line drugs rather than conventional NSAID therapy. Additionally, it is also recommended to gradually decrease the dosage of corticosteroids.

KEYWORDS:

Cervical CT; Corticosteroid; Crowned dens syndrome (CDS); NSAIDs; Transverse ligament of atlas (TLA)

PMID:
28431628
DOI:
10.1016/j.jns.2017.02.050
[Indexed for MEDLINE]

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