An Uncommon Presentation of Crowned Dens Syndrome Without Systemic Inflammation

Crowned Dens Syndrome (CDS) is a rare but important consideration in the differential diagnosis of cervical spine pain in older adults. CDS is characterized by calcium pyrophosphate dihydrate (CPPD) crystal deposition around the odontoid process, often leading to symptoms that overlap with more common conditions such as rheumatoid arthritis (RA), meningitis, or cervical spondylosis. We report the case of a 74-year-old male with chronic neck pain and restricted cervical range of motion. Advanced imaging revealed characteristic calcifications surrounding the odontoid process, pannus formation, and erosive changes at the C1-C2 articulation, consistent with CDS. Clinical evaluation supported a diagnosis of CPPD-related CDS. The patient was successfully managed conservatively with nonsteroidal anti-inflammatory drugs and physical therapy, with notable symptomatic improvement over time. This case reinforces the utility of CT imaging in diagnosing CDS and differentiating it from other inflammatory or degenerative cervical conditions. Awareness of CDS and a high index of suspicion are essential for early diagnosis, appropriate treatment, and avoidance of unnecessary interventions. Conservative management remains effective in most cases; however, further studies are necessary to evaluate alternative therapies for refractory presentations.