gms | German Medical Science

Obbjective: Degeneration of the atlanto-dens 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 atlanto-dens and atlanto-axial facet joints.

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

Results: The atlanto-dens interval narrowed linearly with age (R2=0.992; p<0.001). The prevalence of intraosseous cysts increased exponentially from 4.2% to 37.4%, and synovitis increased from 0% to 11.1%. Intraosseous cyst formation generally began in the 2nd to 3rd decade of life and synovitis in the 5th and 6th decade of life. Facet joints also demonstrated age related changes; however, the rate of degenerative changes was lower than in the atlanto-dens joint.

Conclusion: To our knowledge, this is the first study that documents specific changes of both atlanto-dens 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.