Crowned dens syndrome

Background: Crowned dens syndrome (CDS) is clinically characterized by acute cervical pain accompanied by peri-odontoid calcifications. Historically considered rare, recent literature and our clinical findings suggest CDS is not uncommon. This study aimed to evaluate the prevalence, etiology, clinical manifestations, imaging features, and treatment outcomes of CDS. Methods: We retrospectively analyzed clinical data from 50 CT-confirmed CDS patients admitted to Guangxi International Zhuang Medicine Hospital between January 2019 and March 2025. Patients were stratified into symptomatic CDS ( n = 26) and asymptomatic CDS ( n = 24) groups based on the presence of acute neck pain and restricted cervical mobility. Collected data included demographics (gender, age, and smoking/alcohol history), comorbidities (hypertension, diabetes), initial clinical departments, and imaging findings. All symptomatic patients were followed to document treatments and symptom recurrence. Results: Among 50 radiologically confirmed CDS cases, 26 (52.0%) were symptomatic and 24 (48.0%) were asymptomatic. Calcifications were observed in all peri-odontoid regions on imaging. The overall male-to-female ratio was 19:31 (ratio = 0.61). Symptomatic CDS patients showed significantly higher proportions of females ( p < 0.05) and older age ( p < 0.05) compared with asymptomatic cases. Age and female gender correlated significantly with symptomatic CDS, while smoking, alcohol use, hypertension, and diabetes showed no significant association. All symptomatic patients achieved substantial symptom relief with nonsteroidal anti-inflammatory drugs or corticosteroid therapy, including recurrent cases. Conclusions: Current under-recognition of CDS contributes to high rates of misdiagnosis and underdiagnosis, suggesting its true incidence likely exceeds reported data. Computed tomography (CT) imaging provides definitive diagnostic evidence. Early intervention with nonsteroidal anti-inflammatory drugs or corticosteroids is critical for improving outcomes in symptomatic CDS patients.