The diagnosis of spinal pain is particularly difficult because of the multitude of possible causes, some common to all levels of the spine, others specific to a given stage. This shows the importance of a diagnostic very systematic approach, based as much on clinical as imaging.
The precise examination:
– The installation mode of pain: gradual or abrupt, succeeding trauma, one wrong move, a sneeze, a lifting force (work accident?);
– Field occurred: history, especially spinal, age, occupation, sporting habits;
– The topography of pain: very localized, multifocal (eg, cervical and lumbar), diffuse;
– The existence of any radiation, systematized (root topography) or less precise;
– The schedule, mechanical or inflammatory;
– Seniority of pain and his progressive profile: acute pain (less than 3 months) or chronic (more than 3 months), progressively worsening or, conversely, somewhat favorable evolution, spontaneously or with treatment (analgesics and / or non-steroidal anti-inflammatory drugs);
– The functional impact (business interruption, bed rest, etc.); a deterioration of general condition, the existence of extraspinal clinical manifestations, etc.
Physical examination search:
– Abnormal spinal posture, overall (scoliosis) or regional:
– Decrease in cervical lordosis stiffly or kyphosis,
– Accentuation of the dorsal kyphosis
– Lumbar lordosis, segmental stiffness with the deletion of lordosis, deviation analgesic bayonet;
– A contraction of the paraspinal muscles; painful elective points Median (thorny, interspinous region) latérovertébraux (facet joint articulation, a sign of the bell) or away from the midline, by maneuvering the pinched-rolled;
– A limitation of mobility, which can not be objectified than at a mobile segment, namely:
in cervical: reduced mobility in flexion (chin-sternum distance) or extended (occiput-wall distance) in latéroflexions or rotations,
– Lumbar: reduced mobility in flexion (remote hands-floor Schöber index), by extension, in side slopes;
– Clinical examination is complete course: general condition, temperature, looking for lymphadenopathy, neurologic examination, pelvic examination, etc.
The search for a anxiodepressive state is essential.
They should be limited in first intention in determining the erythrocyte sedimentation rate (ESR) and the protein content of C-reactive protein (CRP).
If the clinical examination did evoke a spinal pathology other than mechanical and degenerative, other laboratory tests must be requested depending on the context:
– If the compression fracture: calcium and phosphate, protein electrophoresis, possibly tumor markers, etc.
– In case of infectious disease suspected: bacteriological samples, serology, etc.
– In case of suspicion of spondyloarthropathy: HLA B27.
First line, they must be limited to plain radiographs:
– For low back pain: clichés lumbar spine front and profile photograph of the pelvis (or large dorsal-lumbar-pelvic-femoral anteroposterior radiograph = incidence De Sèze) and possibly face clichés centered L4 discs / L5 and L5 / S1 and oblique impacts (spondylolysis suspicion);
– For back pain: shots of the back and lateral spine;
– For neck pain: cervical plates and lateral spine, possibly clichés face open mouth (releasing C1 / C2) and oblique impacts.
In the clinical context, numbers of ESR and CRP and standard imaging, other more sophisticated tests may be required: bone scan, CT scan, MRI, lumbar discography and myelography (possibly supplemented by a scanner).
Depending on the etiological, other tests may be justified:
– Study of cerebrospinal fluid: chronic meningitis is suspected or meningoradiculitis;
– Vertebral biopsy tumor and infectious diseases.
We must eliminate a extraspinal pathology.
Many visceral diseases can mistakenly impose for spinal pathology (referred pain). This possibility should be considered when spinal pain is not related to the movement, it is not found by the spinal palpation and imaging is negative.
We must eliminate retroperitoneal fibrosis, an abdominal aortic aneurysm, renal disease (hydronephrosis, tumor) or pelvic (ovary). An abdominopelvic CT scan must be requested in doubt.
The search for a referred pain of visceral origin is imperative because especially common:
– Digestive causes hiatal hernia, peptic ulcer, gallstones, gastroesophageal, or pancreatic cancer;
– Pleuropulmonary causes: pleural effusion, pneumothorax, pleuropulmonary cancer;
– Cardiovascular causes pericarditis, coronary artery disease, thoracic aortic dissection aneurysm cracking.
Must eliminate original ORL pain, esophageal or thyroid. Brain tumors in the posterior fossa may also present with neck pain.
The original mechanical spinal pain is suspected in:
– The preservation of the general condition with no fever;
– The mechanical time of pain;
– The existence of a mechanical triggering event;
– The tendency to spontaneous or under common symptomatic improvement;
– Normality of ESR and CRP.
Mechanical low back pain appearance:
Acute back pain:
Two main diagnoses must be considered: acute low back pain of discogenic lumbago or vertebral collapse and complicating osteopathy benign desalting, first and foremost osteoporosis. Other diagnoses are sometimes mentioned.
It reflects acute disc pathology, with migration of part of the core (nucleus) in a crack of the fibrous ring (annulus). This crack is perpendicular to the fiber axis and is located in the posterior part of the ring, which is both more fragile and more innervated, hence pain. Nuclear migration in the annulus can stay intradiscal or protrude into the spinal canal and then form a herniated disc. Such a hernia can be median, causing only lumbar pain phenomena, or posterolateral, and then capable of compressing a nerve root: conflict related nerve at the root of sciatica (L5 or S1) or lombocruralgie (L3 or L4).
The disc acute low back pain occurs mostly in young, often abruptly as a result of a lifting load anteflexion, a sporting effort, sneezing, etc. It operates in a mechanical rhythm and is characterized by its impulsive character coughing, sneezing and the defecation, all circumstances being accompanied by an increase in intradiscal pressure.
On examination, there is often a lumbar blocking anteflexion and / or analgesic deviation bayonet, with palpable contraction of the paraspinal muscles and sign bilateral lumbar Lasègue (alarm or exacerbation of low back pain to maneuver Lasègue).
nerve root compression signs may be associated.
Plain radiographs, if requested, are normal or indicate a degenerative disc space narrowing with any commonplace arthritic lesions.
Achieving a scanner has no interest, except in cases of frequent and disabling relapses.
Collapsed vertebra “Benin”:
Found most often in the elderly, usually in the context of demineralization osteoporotic, vertebral fracture syndrome occurs suddenly, after a fall or moderate effort, sometimes even spontaneously.
It is manifested by acute pain with lumbar stiffness, mechanical rhythm, with spontaneous improvement trend, without fever or impaired general condition or signs of nerve root compression or tail-to-horse.
The lameness can be major, with the obligation to complete bed rest.
The sedimentation rate is normal and a calcium and phosphate should be sought. Normal in osteoporosis, it may point to another cause benign desalting osteopathy (hyperparathyroidism, osteomalacia) in case of anomalies. The diagnosis of settlement based on plain radiographs, which also help provide arguments for his goodness (but falsely reassuring aspect is not uncommon in cases of settlement “malignant”): settlement of a superior endplate or lower, or biconcave vertebra, or anterior wedge packing (a comprehensive settlement, “pancake” is much more suspect), with respect cortical rim and posterior wall without pedicle lysis or soft tissue abnormalities.
If in doubt persistent with vertebral collapse of malignancy, bone scintigraphy (uptake) and MRI (T1 hypointense and T2 hyperintense) do not allow to be discriminating in the first two months and only the spinal biopsy performed when in doubt, eliminates compaction symptomatic tumor or infection.
Other causes of acute low back pain mechanical:
Osteoarthritis facet joint, the main cause of chronic low back pain, can eventually manifest acutely, sometimes in the aftermath of a torsional movement. then invokes a sprain phenomenon or a localized inflammatory flare. Other causes of chronic back pain can lead to acute painful episodes: spondylolisthesis, osteoarthritis interspinous (Baastrup syndrome).
Chronic low back pain:
Two main diagnoses must be considered: articular pathologies original post and chronic low back pain of discogenic.Other etiologies, rare, may also be mentioned.
Articular pathologies interapophysaire original post:
The achievement of the facet joints (mainly on levels L4 / L5 and L5 / S1) is by far the predominant cause of chronic low back pain. However, the precise mechanisms behind pain are poorly understood.
Chronic back pain of facet joint origin (or facet joint syndrome) rather concerns matters beyond 40 years.
Pain, low back, bar or frankly lateralized, evolves in a mechanical rhythm but can be insomniante to changes in position and is usually accompanied by a brief morning stiffness (under 15 minutes). It is highest in sitting and standing positions extended and more trampling (museum visits, etc.). It also triggered or exacerbated by prolonged prone position. Finally, it can be accompanied by referred pain (or referred to) in the buttocks, trochanteric regions, groin and back of thighs, rarely exceeding popliteal, and probably related to a suffering of the posterior branch ( purely sensory) nerve to spinal pathological stage.
On physical examination, essentially finds, in a readily hyperlordotique subject, limiting the lumbar extension, contrasting with proper anteflexion and elective paraspinal pain at the push of one or more facet joints. However, there is no Lasegue or signs suggestive of root compres sion. Plain radiographs (including oblique impacts) are normal or show signs of facet joint osteoarthritis: hypertrophy and condensation facet joints, pinching or loss of the joint space interfacettaire. Degenerative spondylolisthesis, generally anterolisthesis type of L4 on L5, is often associated, as well as signs of degenerative disc disease.
The scanner, when performed, allows to find optionally:
– Joint original posterior osteophytes, a root canal or rétrorachidien development;
– Acquired a narrowing of the spinal canal, often of mixed origin, disc (protrusion or herniated disc median) and facet joint osteoarthritis, suspected on the association to back pain neurogenic claudication of the lower limbs;
– Cyst of posterior articular origin, individualized best by arthrography, scanner, possibly responsible for a genuine root compression.
Nevertheless, as with any arthritic condition, it should be noted here the absence of radiological parallelism.
Chronic low back pain of discogenic:
Often associated with the previous, it also occurs beyond 40 years, progressively, often after a long history of recurrent acute low back pain and / or sciatica.
The low back pain is rather median, evolving form of painful flares on a permanent painful background. She is impulsive and rather inconsistently awakened by the positions held anteflexion (ironing, dishes, etc.). Physical examination sometimes finds a sign of lumbar Lasègue and painful limitation of anteflexion.
Plain radiographs gladly meet disc space narrowing (or stepped pinching) with presence of gas (phenomenon of disc blank).
discarthrose of lesions, with condensation of the endplates and anterolateral osteophytes péricorporéaux are common, readily associated with facet joint osteoarthritis lesions. At the extreme, far beyond the sclerosis in the vertebrae surrounding the disc space narrowing, with geodes and possible irregularities of the vertebral plates. This “pseudopottique” aspect may warrant further explorations (MRI).
* Lumbar Canal narrowed:
He associates with low back pain of facet joint origin, fatigability of the lower limbs for walking, causing the patient to stop or even bend forward or sit before leaving (neurogenic claudication sensorimotor).
Diagnosis, talked about the clinic, confirmed by CT, MRI or lumbar myelography (interesting as to assess the spinal caliber and standing in dynamic situations).
* Baastrup syndrome:
It corresponds to an interspinous néoarthrose and occurs in frequent association with previous pathologies, among hyperlordotic patients.
* Trophostatique Syndrome postmenopause:
It corresponds to a combination frequent symptomatic in women beyond 60 years: obesity with sagging abdominal, lumbar lordosis and kyphosis, frequent thoracolumbar scoliosis, degenerative origin amid stepped disc disease with facet joint osteoarthritis.
In this situation frequently incorporate sequelae images of osteoporotic vertebral fractures.
* Spondylolisthesis in young patients:
It predominates upstairs L5 / S1 and complicated bilateral spondylolysis of L5, but probably congenital readily increased by predisposing certain activities (ballet, gymnastics, etc.), with repeated efforts in lordosis. It may be asymptomatic and discovered incidentally or cause chronic back pain, possibly supplemented by clinical evidence of nerve root compression, the mechanism is not unique (disc disease associated fibrous nodule isthmus, narrowing canal or foramen, etc.).
* Scheuermann’s disease (spinal growth epiphysitis):
It can cause chronic back and back pain in adolescents and young adults, but is usually asymptomatic in most elderly, in whom subsist only radiological consequences of accidental discovery, typically combining:
– An irregular, laminated, some endplates, whose stability can eliminate a discite;
– Intraspongieuses of hernias with possibly pinch corresponding disc spaces;
– More rarely, a tapering of the front corners of the vertebrae, or a welding defect of the marginal strip.
* Disease Forestier (vertebral hyperostosis sheathing):
It can be the cause of back pain and chronic low back pain with reduced flexibility, but it is primarily a radiological entity, characterized by an exuberant cast ostéophytique “bridge” next straight anterolateral faces of the dorsal vertebrae and lumbar aortic beats preventing the development of these osteophytes to the left side surface of the thoracic spine. This gross osteophytes, to distinguish fine syndesmophytes spondylarthropathies, can also be found in the pelvis, hips, knees, etc.
* Syndrome of the posterior branch of D12:
It is the cause of low back pain (lumbosacral hinge) high origin (thoracolumbar junction) and is accompanied by referred pain to the iliac crests and cellulalgiques areas facing the lumbar pits detected by the pinch method rolled.
* Paget’s disease:
His spinal locations are rarely painful, unless complications (compression, nerve root compression, sarcomatous degeneration).
Similarly, the true lumbar scoliosis (with rotation of the vertebral body), and scoliosis (without rotation of the vertebral body) are conventionally not generating chronic pain.
Functional low back pain:
Very frequently, they must not constitute a diagnosis of exclusion of the aforementioned pathologies, but must be detected by a careful assessment of history, context, functional complaint, the patient’s personality and a thorough clinical examination.
Usually the so-called functional low back pain is the mark of a trivial symptoms in relation to classical vertebral pathology. Should be considered as guidance for a primarily functional component:
– The field: rather a young woman, with a history of depression, anxiety land (colopathy frequent spasmodic), professional difficulties and / or marital or context sinistrosique searchable secondary benefits in the aftermath of an accident or the highway ;
– Characteristics of pain: often described as permanent, insomniantes willingly bifocal (lumbar and cervical), and even extended to the entire spine, or integrating sometimes in a state with fibromyalgia widespread pain in ancient general and “making life increasingly unbearable “;
– Resistance to conventional treatments;
– The contrast between the importance of the complaint and the lack of objective signs on physical examination;
– Negativity further investigations.
Sometimes, chronic low back pain reveal genuine psychiatric disorder: real depression, conversion hysteria.
Mechanical look back pain:
Acute back pain:
After elimination of referred pain of visceral origin, the only diagnosis to remember in this context is the mechanical pain Benin vertebral collapse, usually osteoporotic (see above). Indeed, the occurrence of a herniated disc at the dorsal level is as outstanding as serious, with almost constant spinal cord compression.
The etiology of chronic mechanical pain of the thoracic spine have already been considered previously and boil down to:
– The discarthrosique degeneration, radiologically frequent but rarely symptomatic;
– Osteoporotic vertebral fracture sequelae;
– Scheuermann’s disease;
– Forestier’s disease;
– Paget’s disease, with risk of spinal cord compression or spinal injuries of vascular origin (hémodétournement);
– Static spinal disorders: back compensation from lumbar scoliosis with hump, accentuation of the dorsal kyphosis;
– Back pain called functional.
Mechanical neck pace:
Acute neck pain:
Outside of trauma, the only diagnosis to remember is that of a stiff neck, frequent, whose origin pathogenesis is not unequivocal, making more use of functional muscle disturbances that true anatomical abnormalities, herniated and / or OA. Torticollis usually occurs in young patients, in whom it is often triggered by a wrong position or wrong move:
– Cervical hyperextension long maintained (painted ceiling, sleep on your stomach, etc.);
– Sudden or prolonged cervical rotation;
– Faulty ergonomics at work (computer monitor placed too high or too low);
– Air flow, etc.
Torticollis results in a very acute neck pain, often of sudden onset, readily associated with a cervical locking anterior and lateral bending. The active and passive mobilization is virtually impossible because of the pain and physical examination should look for signs suggestive of nerve root compression (cervical radiculopathy), whose existence is for a herniated disc.
The outcome was favorable in a few days, either spontaneously or as conventional drug therapy.
Plain radiographs are normal or willingly reveal correctness of the cervical spine, or even a kyphosis, possibly associated with discal pinching and / or arthritic abnormalities.
For the record, a cervical vertebral compression is always symptomatic of an inflammatory pathology, infectious or tumor and thus causing an inflammatory neck pace.
Indeed, fractures related to osteoporosis are for the lumbar and thoracic vertebrae below T4, but never the cervical vertebrae.
Chronic neck pain:
Common neck pain:
This term refers to chronic neck pain responding to various anatomical lesions, often associated with each other about the stereotypes of the cervical spine.
* Degeneration disc:
It predominates in C5 / C6 and C6 / C7 with pinch, sometimes voluminous anterior osteophytes and disco-bar ostéophytique posterior root canal development, condensing the adjacent endplates.
* Uncarthrose and facet joint osteoarthritis:
They are good views of the oblique impacts and can shrink the size of the foramen.
Neck pain are of varying intensity, sometimes insomniantes with limited mobility, especially in rotations. Various neurological diseases may be associated with these chronic neck pain and are directly consecutive to arthritic lesions.
* Facet joint syndrome:
It has signs of irritation of one or more posterior branches of spinal origin, with pain projected to the inside of the scapula, occipitalgies, trapézalgies and radiation poorly systematized pseudoradiculaires in the upper limb, without objective signs of cervical radiculopathy . The cervical hyperextension highlights neck pain and referred pain. Finally, the paravertebral palpation readily found elective pain at the push of one (or more) facet joint articulation.
In this context, the Arnold neuralgia corresponds to the irritation of the posterior branch of the second cervical root, with pseudomigraineuses pain may radiate to the upper cervical region to the front region.
* Cervico brachial neuralgia:
The occurrence of cervicobrachial neuralgia with nerve root compression of disco-ostéophytique origin in the spinal canal or the foramen can be observed. It can justify carrying out neuroimaging studies (CT and / or MRI).
* Cervical spondylotic myelopathy:
It complicates an advanced cervical spondylosis with osteophytes after corporeal pluriétagée to root canal development. It should be suspected in the gradual onset of paraesthesia of four members, with feeling of heaviness and fatigue on exertion. Neurological examination revealed signs of spinal cord compression syndrome with tetrapyramidal. MRI of the cervical spine is the complementary examination of choice for confirming the diagnosis and treatment decisions. Indeed, surgery (laminectomy fusion ±) is the only solution when an MRI revealed a complicated spinal canal narrow signs of suffering.
Paget’s disease can be complicated by cervical localizations. Besides the conventional vertebral malformations (vertebra frame, condensed and hypertrophic exceeding the alignment of other vertebrae), an acquired block of appearance of two or more vertebrae is possible. This spinal disease may be complicated by a narrowing of the spinal canal with spinal cord compression table. A phenomenon of hémodétournement ( “vascular steal”) in favor of pagetic bone and to the detriment of the spinal cord is also possible, but more often dorsally.
The locations in the cervical spine chronic inflammatory rheumatism (PR and spondyloarthritis) can cause chronic vicalgies cer mechanical pace, distance initial inflammatory phenomena.
Functional neck pain:
They share the same characteristics as the functional back pain, which they associate also often. In Lieou Barré-syndrome, neck pain these are part of a rich functional procession, further headache, occipital or more diffuse, tinnitus, visual disturbances (phosphenes, blurred vision), sleep disorders, irritability , general fatigue. These functional symptoms are also common in the aftermath of neck injuries with classic “whiplash”.
The origin of inflammatory spinal pain is suspected in:
– A poor general condition and / or the existence of a fever;
– Schedule inflammatory pain; progressive worsening pain without notion of initial triggering event;
– Moderate or no effectiveness of conventional drug treatments;
– Increased ESR and CRP.
Inflammatory low back pain appearance:
Acute back pain:
Three categories of causes should be mainly discussed: a spinal tumor pathology with or without compacting, spondylodiscitis pyogenic, spondyloarthropathy.
Other rarer diagnoses are possible.
Bone tumor pathologies:
They must be feared all the more the patient is elderly. This is usually osteolytic malignant tumors: metastases mainly (kidney, breast, lung, thyroid, testis) or myeloma. More rarely, osteolysis is associated with a solitary plasmacytoma, a lymphoma localization, Hodgkin or not, or a primary tumor (osteosarcoma, chondrosarcoma, chordoma).
Pain, inflammatory typically is accompanied by a significant segmental stiffness and often neurological signs: radiculopathy (willingly multiple), syndrome-tail horse, which must be suspected invasion of the epidural space (epidural tumor).
Plain radiographs can show osteolytic lesions:
– Vertebral fracture, tumor whose origin is suspected in various abnormalities: cortical lysis collapse of the posterior wall;
– Achievement of the posterior arch: pedicle lysis (vertebra blind or blind), lysis of an articular blade, a spinous process.
When plain radiographs are normal or that there is a recent settlement without obvious lytic image but clinically suspect (neoplastic history, inflammatory rhythm), various imaging tests can be performed:
– Bone scan, whose uptake on the vertebra is packed in specific malignancy nothing but which can reveal other hyperfixantes bone lesions, highly suggestive of metastases (note the lack of uptake classic myeloma lesions );
– The scanner, which can objectify cortical defects, an invasion of adjacent soft tissue, invasion of the epidural space;
– Especially, MRI of the lumbar spine, which provides the same information as the scanner and may reveal subclinical dissemination of bone lesions.
In case of persistent doubt, vertebral biopsy is needed. Sometimes there are osteoblastic lesions with or without compaction, which, in the absence of bone hypertrophy characteristic of Paget’s disease should be suspected metastases (prostate cancer primarily, sometimes breast cancer or lung) or, exceptionally, non-Hodgkin lymphoma or plasmacytoma.
Sometimes adolescents and young adults, it is a benign tumor, which insomniant character should suggest first osteoid osteoma one, especially if that nocturnal back pain is particularly sensitive to aspirin.
Diagnosis is based on the scan and the scanner, which reveals an often pedicle topography of tumor. More rarely, the tumor is benign, almost always in a child or adolescent, a Benin ostéoblastome an aneurysmal cyst or eosinophilic granuloma.
They must be systematically evoked when the pain is particularly acute, and operates in a context septic fever with chills, biological inflammation (elevated ESR and CRP, leukocytosis with polymorphonuclear). Lumbar stiffness is greater and the onset of a neurological event is usually related to an extension of lesions in the epidural space (epidural infectious). The lesion diagnosis is best done by MRI and bacteriological diagnosis by vertebral biopsy.
They can cause acute back pain episodes of inflammatory pace at the start and evolving, often associated with buttock pain associated with sacroiliitis unilateral or bilateral.
Some intraspinal tumors, dominated by the neuroma, cause of back pain in early electively night ( “pain tall”). The diagnosis of intraductal tumors (neuroma or meningioma or ependymoma) based on MRI.
Some meningitis can result in acute low back pain sometimes indicative of inflammatory pace, possibly supplemented with radicular pain (meningoradiculitis). This is meningitis “aseptic” related to various microbial agents: Borrelia burgdorferi (Lyme disease) or virus (herpes, varicella-zoster, HIV [ciency virus immunodéfi human], HTLV-1 [T virus -lymphotropique human]).
Exceptionally, acute low back pain can be attributed to non-bacterial disc inflammation (inflammatory discitis). Outside discites spondylarthropathies, we must mention the herniated suffering from rheumatism or chondrocalcinose to hydroxyapatite, with images of intradiscal calcifications (nucléopathie calcifying).
LBP subacute or chronic:
Multiple diagnoses can be mentioned:
– TB and brucella spondylitis;
– Bone tumor diseases, malignant or benign;
– Ankylosing spondylitis and spondyloarthritis;
– Intraspinal intraductal tumors;
– Chronic meningitis Lyme disease.
Back pain of inflammatory pace:
In this context, to evoke the etiologies are virtually identical to those of the IBP:
– Bone tumor pathologies, dominated by metastases and myeloma locations;
– Spondylodiscitis banal germs or tubercle bacilli;
– Intraductal tumors.
However, dorsally, narrow the spinal canal, as compared to the lumbar level, accounts for the frequency and the occurrence of speed neurological complications, type of compression of the spinal cord or conus, particularly in infectious and tumoral pathologies.
Cervical pain of inflammatory pace:
Again, the causes are roughly identical to those set out above for the lumbar and dorsal floors, dominated by infectious and bone tumors.
However, we must mention two inflammatory diseases whose locations are specific to the cervical spine: the rheumatoid arthritis and the crowned tooth syndrome.
Achieving cervical spine is common in evolving.
The high cervical spine is most often concerned with anterior dislocation C1 / C2 by destruction of retro-odontoid and transverse ligament risk of spinal cord compression.
This complication usually manifests debilitating inflammatory neck pain, but it can be asymptomatic. His diagnosis is made on the clichés of the cervical spine in flexion and extension profile, with demonstration of a pathological diastasis (> 3 mm) between the anterior arch of the atlas and dens.
MRI is also very contributive.
More rarely, the achievement is on the way and lower cervical spine: discites inflammatory erosive arthritis later interapofisarias, overhead or anterolisthesis often unstable.
Syndrome crowned tooth:
The crowned tooth syndrome corresponds to an acute neck pain very often inflammatory and febrile, pseudoméningée in connection with a microcrystalline access (calcium pyrophosphate or hydroxyapatite) from the retro-odontoid transverse ligament. When the diagnosis is suspected, it can be confirmed that the scanner centered on C1 / C2, which reveals Arcuate calcifications within the transverse ligament.