title: Prevalence of degenerative changes of the atlanto-axial joints.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To document age-related degenerative changes of the cervical spine in a large cohort of patients.
  
  
  METHODS
  This is a retrospective cohort study.
  
  
  METHODS
  Adult trauma patients were admitted to our Level 1 trauma center.
  
  
  METHODS
  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.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Marcel W
authors.initials: MW
authors.lastname: Betsch
authors.affiliation: Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Sabina R
authors.initials: SR
authors.lastname: Blizzard
authors.affiliation: Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Shinseki
authors.affiliation: Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA. Electronic address: yooj@ohsu.edu.
authors.forename: Jung U
authors.initials: JU
authors.lastname: Yoo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D010003:Osteoarthritis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015995:Prevalence; D011859:Radiography; D012189:Retrospective Studies; D013585:Synovitis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D055815:Young Adult; D021801:Zygapophyseal Joint / Q000000981:diagnostic imaging*
keywords: Calcific synovitis; Cervical spine; Dens fracture; Intraosseous cyst; Osteoarthritis; Risk factors