title: Acute neck pain caused by arthritis of the lateral atlantoaxial joint.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To clarify whether the lateral atlantoaxial joint is involved in acute neck pain among elderly individuals by conducting lateral atlantoaxial joint puncture.
  
  
  METHODS
  A prospective study.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Orthopedic Surgery, Akita Kumiai General Hospital, 1-1-1 Nishifukuro, Iijima, Akita 011-0948, Japan. Electronic address: takakoba825@hotmail.com.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Miyakoshi
authors.affiliation: Department of Orthopedic Surgery, Koto General Hospital, 37 Kawasaki-Kaiho, Hachirogata 018-1605, Japan.
authors.forename: Norikazu
authors.initials: N
authors.lastname: Konno
authors.affiliation: Department of Orthopedic Surgery, Akita Kumiai General Hospital, 1-1-1 Nishifukuro, Iijima, Akita 011-0948, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Abe
authors.affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ishikawa
authors.affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Shimada
mesh_terms: D059787:Acute Pain / Q000209:etiology*; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000150:complications*; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology*; D011859:Radiography
keywords: Acute neck pain; Calcification; Calcium pyrophosphate dihydrate; Lateral atlantoaxial joint; Pseudogout; Puncture