BACKGROUND CONTEXT: Crowned dens syndrome (CDS) is a rare form of calcium 
phosphate crystal depositions and often presents with recurrent neck pain, 
stiffness of neck, increased erythrocyte sedimentation rate, and episodes of 
fever.
PURPOSE: The goal of this report is to identify the early and late stages of CDS 
and its consequences as the result of repeated attacks of CDS at cervical spine 
in its late stage.
STUDY DESIGN: This is a case report.
METHODS: We reported one case of early-stage CDS and one late-stage CDS.
RESULTS: The two patients shared some common clinical features of acute attack 
of CDS, such as increased erythrocyte sedimentation rate, C-reactive protein, 
episode of fever, and increased white blood cells along with high blood glucose 
levels. The first case showed early phase of CDS with computed tomography (CT) 
scan that only showed mild calcification around the dens. The second case had 
appearance of late stage of CDS with more severe chronic degenerative changes of 
cervical spine.
CONCLUSIONS: Early stage of CDS can be difficult to identify because of mild 
clinical symptoms, but CT scan is a preferable method to demonstrate densities 
surrounding the top and sides of the odontoid process. In the late stage of CDS, 
radiolographic features often include diffuse periodontoid calcifications, 
diffuse destructive discopathies, and apophyseal joint destruction, and patient 
might have severe neurological symptoms.