Calcification of the transverse ligament of the atlas in chondrocalcinosis: computed tomography study.

The crowned dens syndrome as a cause of neck pain: Report of two new cases and review of the literature

“…There are several reports of compressive cervical myelopathy caused most commonly by CPPD deposition of the ligamentum flavum (10,18 -20). Additionally, several groups have reported case series of CPPD crystal deposition of the periodontoid region, most commonly of the transverse ligament of the atlas (17,(21)(22)(23)(24)(25)(26)(27). Periodontoid CPPD crystal deposition was demonstrated by Dirheimer et al (22) in a study in which 27 neurologically asymptomatic patients with articular chondrocalcinosis were imaged by cranial-cervical junction X-ray polytomography.…”

“…Twelve patients (44%) were found to have syndesmoodontoid joint calcification. More recently, Constantin et al (24) reported on axial CT scanning of the cervical-occipital hinge of 21 patients with articular chondrocalcinosis. Fourteen patients were found to have calcification of the transverse ligament of the atlas, including all 5 patients with acute neck pain.…”

“…Fourteen patients were found to have calcification of the transverse ligament of the atlas, including all 5 patients with acute neck pain. It has been postulated that CPPD deposition of the atlantoaxial joint can be explained by the presence of chondroid cells within the transverse ligament of the atlas, thus rendering it structurally analogous to the meniscus of the knee, a fibrocartilaginous structure (24). Others have suggested that fibroblasts within cervical spine ligaments can transform into chondrocytes, thus making these ligaments susceptible to calcification (28,29).…”

The crowned dens syndrome. Evaluation with CT imaging

“…The differential diagnosis is not easy [1]. According to available data [7][8][9][10], computed tomography (CT) imaging at the C1-C2 level is still the reference standard and is superior to magnetic resonance imaging (MRI) in identifying these calcifications, especially when they are small [11].…”

Compressive cervical myelopathy due to massive periodontoid calcium pyrophosphate crystal deposition

“…I depositi vertebrali di pirofosfato di calcio sono classicamente riscontrabili nei dischi intervertebrali e nei legamenti gialli, tuttavia possono essere presenti anche in sede periodontoidea interessando in particolare il legamento alare ed il legamento trasverso dell'atlante (3). Ad una valutazione sistematica, tali depositi sono stati riportati nel 44% delle politomografie radiologiche convenzionali e nel 66% delle tomografie computerizzate dell'articolazione atlo-epistrofica di pazienti con condrocalcinosi già evidenziata in altre sedi (4,5). La maggior parte di questi casi non presen-Figura 1 -Risonanza magnetica nucleare: la scansione sagittale con pesatura T2 evidenzia un anomalo tessuto epidurale, con bassa e inomogenea intensità di segnale, localizzato appena posteriormente al processo odontoideo, che comprime il midollo spinale.…”