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Intraosseous dens cysts and retro-dens synovitis likely to occur with dens fractures
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A retrospective level 3 study identified two factors that are likely to be present in elderly patients with dens fractures following trauma.
“Our study clearly demonstrates that degenerative changes consisting of a subchondral cyst within the dens and synovitis surrounding the dens were associated with a dens fracture in this sample of trauma patients. Intraosseous cysts were nearly eightfold more common among those with a dens fracture, as compared with patients without such a fracture, and peri-dens synovitis was nearly fivefold more common. Our data suggest the possibility that cysts and synovitis together have an additive effect on the risk of a dens fracture,” Matthew S. Shinseki and colleagues wrote in the study.
The investigators included 1,794 trauma patients aged 55 years or older who had a CT scan of the cervical spine when admitted to their level-I trauma center. Scans revealed 56 patients with a dens fracture and investigators used a random sample of 736 patients without a dens fracture.
Shinseki and colleagues found an intraosseous cysts in the dens in 16.4% of patients without a dens fracture and 3% of patients with a dens fracture, based on the results.
“The dens fracture extended through the existing cyst in 24, 66.7%, of 36 patients with a cyst and a dens fracture. Retro-dens synovitis was present in 4.2% of the patients without a dens fracture and 25% of those with a fracture,” they wrote.
Factors found in the study to contribute to a dens fracture were osteoporosis and other diagnoses related to aging.
“Additional studies aimed at understanding factors contributing to dens cyst formation and synovitis could help to prevent this devastating injury,” Shinseki and colleagues wrote.
Disclosure: One or more of the authors, or his or her institution, has had a financial relationship, in the 36 months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work.
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Shinseki MS. J Bone Joint Surg Am 2014;doi:10.2106/JBJS.M.00814.
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