BACKGROUND: Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is 
one of the most common forms of crystal-associated arthropathy in the elderly. 
However, CPPD deposition on the cervical spine is less well known, and only a 
limited number of cases have been reported to date. Here, we report our recent 
clinical experience with CPPD crystal deposition disease of the cervical spine 
and describe the clinical features of this disease.
METHODS: Fourteen patients with clinically diagnosed CPPD crystal deposition 
disease of the cervical spine at our department during the period from January 
2005 to December 2008 were analyzed retrospectively.
RESULTS: Patients ranged in age from 54 to 92 (mean+/-SD, 77.5+/-8.5). Chief 
symptoms of patients were acute posterior neck pain and fever. All patients had 
markedly restricted neck rotation. Serum CRP level was highly elevated in all 
patients (10.16+/-5.35 mg/dL). Computed tomography of the cervical spine 
demonstrated linear calcific deposits in the transverse ligament of atlas 
(crowned dens syndrome) in all patients. Calcific deposits were also found in 
other periodontoid structures and the ligamenta flava in some patients. 
Posterior neck pain, fever, and increased serum inflammatory indicators were 
relieved within 1 to 3 weeks by nonsteroidal antiinflammatory drugs (NSAIDs) or 
a combination of NSAIDs and prednisolone. Most of the patients were misdiagnosed 
as having other diseases before consultation.
CONCLUSIONS: CPPD crystal deposition disease of the cervical spine is one of the 
most common underrecognized causes of acute neck pain in the neurology 
department, especially in elderly patients.