scholarly journals Multilevel calcium pyrophosphate dihydrate deposition in cervical ligamentum flavum: clinical characteristics and imaging features

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yueh-Hsiu Lu ◽  
Hsi-Hsien Lin ◽  
Hsuan-Ying Chen ◽  
Po-Hsin Chou ◽  
Shih-Tien Wang ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Clinical Characteristics ◽  
Ligamentum Flavum ◽  
Case Series ◽  
Calcium Pyrophosphate ◽  
Calcium Pyrophosphate Dihydrate ◽  
Imaging Features ◽  
Crystal Deposition ◽  
Ossification Of Ligamentum Flavum ◽  
Pyrophosphate Dihydrate

Abstract Background Involvement in cervical ligamentum flavum is a rare manifestation of the calcium pyrophosphate dihydrate deposition disease. Only few cases of this condition have been reported. We revealed eighteen cases of CPPD in cervical ligamentum flavum that diagnosed at a single medical center. In our case series, clinical characteristics and magnetic resonance imaging findings of patients are described. Methods We retrospectively reviewed the medical charts and imaging studies of the eighteen patients with pseudogout attack of the cervical ligamentum flavum. In addition, we discussed the differences between this disease and ossification of ligamentum flavum in image manifestations. Results There were fourteen men and four women aged between 59 and 87 years. Diabetes mellitus and hypertension were the most common comorbidities. Myelopathy and neck pain were presented in most patients. C4–5 and C5–6 were attacked most frequently, and multiple- rather than single-level involvement could be observed in our series. “Acute on chronic phenomenon” was a specific magnetic resonance image finding in patients whose symptom durations were between 2 to 5 months. Compared to ossification of ligamentum flavum, calcium pyrophosphate dihydrate crystal deposition had different image signs, including morphology, side of the involved ligament, no continuity with the lamina, acute on chronic phenomenon, and presence of retro-odontoid mass. Conclusions Nodular calcifications in cervical ligamentum flavum raise highly suspicion for calcium pyrophosphate dihydrate deposition and must be diagnosed by histological examination and polarized light microscopy. This disease is different from ossification of ligamentum flavum, and it could be recognized by specific image features.

Calcium pyrophosphate dihydrate crystal deposition disease in the cervical ligamentum flavum

1988 ◽  
Vol 68 (4) ◽  
pp. 613-620 ◽  
Author(s):  
Nobuyuki Kawano ◽  
Takashi Matsuno ◽  
Shichiro Miyazawa ◽  
Hideo Iida ◽  
Kenzoh Yada ◽  
...  
Keyword(s):  
Ligamentum Flavum ◽  
Calcium Pyrophosphate ◽  
Calcium Pyrophosphate Dihydrate ◽  
Crystal Deposition ◽  
Content Type ◽  
X Ray ◽  
Crystal Deposition Disease ◽  
Deposition Disease ◽  
Pyrophosphate Dihydrate ◽  
Fine Print

✓ The authors describe three cases of cervical radiculomyelopathy caused by calcium pyrophosphate dihydrate crystal deposition disease (CPPDcdd). Radiological investigations revealed nodular calcifications, 5 to 7 mm in diameter, in the cervical ligamentum flavum compressing the spinal cord. Light microscopic, scanning electron microscopic, and x-ray diffraction studies were performed on all three surgical specimens obtained by laminectomy. In two of the cases x-ray microanalysis and transmission electron microscope studies were also performed. This study defined the presence of two patterns of crystal deposition in the ligamentum flavum. One is a nodular deposit, in which hydroxyapatite crystals are seen in the central part of the nodules, with calcium pyrophosphate dihydrate (CPPD) being distributed thinly around them. The other pattern is a linear deposit seen in multiple ligaments and composed of pure CPPD, which causes minimal thickening of the ligaments. A transitional pattern between the two types was also observed. This study revealed details of the nodular deposition of crystals in the ligamentum flavum and demonstrates that CPPDcdd and so-called “calcification of the ligamentum flavum” are the same disease: namely, CPPDcdd. Hydroxyapatite is assumed to have been transformed from CPPD.

Myeloradiculopathy Secondary to Pseudogout in the Cervical Ligamentum Flavum: Case Report

Neurosurgery ◽  
1989 ◽  
Vol 25 (2) ◽  
pp. 298-302 ◽  
Author(s):  
Heldo Gomez ◽  
Samuel M. Chou
Keyword(s):  
Ligamentum Flavum ◽  
Polarized Light ◽  
Granulomatous Inflammation ◽  
Causative Factor ◽  
Calcium Pyrophosphate ◽  
Surgical Removal ◽  
Calcium Pyrophosphate Dihydrate ◽  
Crystal Deposition ◽  
X Ray ◽  
Pyrophosphate Dihydrate

Abstract A case of cervical myeloradiculopathy secondary to deposits of calcium pyrophosphate dihydrate (Ca2P2O7 2H2O) (CPPD) crystals in the degenerating ligamentum flavum, with marked granulomatous inflammation, is presented. This uncommon clinical presentation of pseudogout (CPPD deposition disease) was confirmed after surgical removal of a compressive cervical ligamentum flavum. The diagnosis of CPPD crystal deposition was determined by polarized light microscopy and energy-dispersive x-ray microanalysis in frozen sections of the biopsy specimen. A review of seven previously reported cases along with the present case failed to reveal trauma as a causative factor.

Intradural calcium pyrophosphate dihydrate deposition disease: case report

2021 ◽  
pp. 1-4
Author(s):  
Ananya Chakravorty ◽  
Ronald T. Murambi ◽  
Ravi Kumar V. Cherukuri
Keyword(s):  
Case Series ◽  
Calcium Pyrophosphate ◽  
Bladder Function ◽  
Calcium Pyrophosphate Dihydrate ◽  
Crystal Deposition ◽  
True Incidence ◽  
Deposition Disease ◽  
Disease Case ◽  
Pyrophosphate Dihydrate ◽  
Periarticular Tissue

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, also known as pseudogout, is a crystalline arthropathy that usually affects large joints and periarticular tissue. Spinal involvement is rare and is usually limited to extradural articular and periarticular structures. Only one case of intradural disease has been previously reported. The authors report the second known case of intradural CPPD deposition disease. An 81-year-old man presented with an 8-week history of urinary and fecal incontinence on the background of long-standing back pain, lower-limb paresthesia, and a known L1 calcified intradural extramedullary mass. Slow growth of the L1 lesion had been documented over several decades on serial CT and MRI. A T12–L2 laminectomy and gross-total resection of the mass was performed. Histopathology demonstrated polarizing rhomboid-shaped crystals consistent with CPPD deposition disease. The patient had significant improvement in bowel and bladder function 6 months postoperatively and made a full recovery. The pathophysiology of intradural involvement remains uncertain. Further case series are required to clarify the true incidence and prognosis of the condition.

Tumoral Calcium Pyrophosphate Dihydrate Deposition Disease of the Ligamentum Flavum

Neurosurgery ◽  
2003 ◽  
Vol 53 (1) ◽  
pp. 103-109 ◽  
Author(s):  
Natarajan Muthukumar ◽  
Usharani Karuppaswamy
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Ligamentum Flavum ◽  
Polarized Light ◽  
Calcium Pyrophosphate ◽  
Calcium Pyrophosphate Dihydrate ◽  
Resonance Imaging ◽  
Ligamenta Flava ◽  
Pyrophosphate Dihydrate

Abstract OBJECTIVE Calcium pyrophosphate dihydrate (CPPD) deposition disease (CPPDD), also known as pseudogout, is rarely known to affect the spine. The purpose of this article is to report our experience with six cases involving massive focal deposition of CPPD crystals in the ligamentum flavum. METHODS Between January 1998 and June 2002, we treated six patients with CPPDD involving the ligamentum flavum of the cervical and thoracic spine. Their ages ranged from 45 to 70 years. There were five female patients and one male patient. The cervical spine was involved in two cases and the thoracic spine in four. All except one patient presented with an insidious onset of myelopathy. The remaining patient presented with paraplegia after trauma. None of the patients exhibited any systemic features of CPPDD or other metabolic conditions that can lead to CPPD deposition. Plain x-rays often yielded inconclusive results. Computed tomography and magnetic resonance imaging were useful in confirming the diagnoses. Decompressive laminectomy, with removal of the ossified ligamenta flava, was performed for all patients. Polarized-light microscopic examinations of the excised ligamenta flava revealed the characteristic rod-shaped, birefringent crystals. RESULTS Five of the six patients experienced significant improvements in their myelopathic symptoms after surgery. The remaining patient experienced improvements in sensations but no appreciable improvement in motor power. During the follow-up periods, which ranged from 7 months to 3 years, none of the patients presented with a recurrence of CPPD crystal deposition at the previously treated level. However, one patient who exhibited improvement after surgery presented 2 years later with a recurrence of myelopathic features attributable to ossification of the ligamentum flavum at a new level. CONCLUSION Tumoral CPPDD of the ligamentum flavum is rare. It commonly occurs among middle-age or elderly female patients and presents with progressive myelopathy. Computed tomography and magnetic resonance imaging are complementary in the diagnosis of this condition. Surgery, if performed early, leads to good improvement. However, long-term follow-up monitoring of these patients is necessary, because surgery provides only symptomatic relief and does not treat the underlying disease. With the increasing availability of magnetic resonance imaging, ossification of the ligamentum flavum is being more frequently recognized. In every case of ossified ligamentum flavum, the excised specimen should be examined with polarized-light microscopy. We think that this simple, inexpensive method will lead to the recognition of more cases of spinal CPPDD.

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