Cervical radiculomyelopathy caused by deposition of calcium pyrophosphate dihydrate crystals in the ligamenta flava

1980 ◽  
Vol 52 (2) ◽  
pp. 279-283 ◽  
Author(s):  
Nobuyuki Kawano ◽  
Sanae Yoshida ◽  
Takashi Ohwada ◽  
Kenzoh Yada ◽  
Kenichi Sasaki ◽  
...  
Keyword(s):  
Polarized Light ◽  
Cord Compression ◽  
Calcium Pyrophosphate ◽  
Calcium Pyrophosphate Dihydrate ◽  
X Ray Diffraction ◽  
Content Type ◽  
First Case ◽  
Roentgenological Examination ◽  
Ligamenta Flava ◽  
Pyrophosphate Dihydrate

✓ A case of cervical radiculomyelopathy caused by multiple calcified nodules in the ligamenta flava is presented. Roentgenological examination of the cervical spine showed radiopaque nodular lesions, 7 × 7 × 5 mm in size, located in the paramedian portion of the posterior spinal canal. The nodules were removed surgically and they were confirmed to be calcifications of ligamenta flava. Microscopic examination of the nodules with the polarized light revealed extensive deposition of crystals. By x-ray diffraction study, the crystal was determined as calcium pyrophosphate dihydrate (CPPD: Ca2P2O7 · 2H2O). Although CPPD deposition in the cartilage has been known as pseudo-gout syndrome, deposition in the ligament has been reported only in a few cases. This is the first case with radiopaque calcified nodules in the ligamenta flava causing spinal cord compression, the composition of which proved to be CPPD.

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.

Calcium pyrophosphate dihydrate deposits in the cervical ligamenta flava causing myeloradiculopathy

1984 ◽  
Vol 60 (1) ◽  
pp. 69-80 ◽  
Author(s):  
Chikao Nagashima ◽  
Motohide Takahama ◽  
Toshikatsu Shibata ◽  
Hiroaki Nakamura ◽  
Keiichi Okada ◽  
...  
Keyword(s):  
Cervical Spondylosis ◽  
Posterior Longitudinal Ligament ◽  
Calcium Pyrophosphate ◽  
Calcium Pyrophosphate Dihydrate ◽  
Cervical Canal ◽  
Posterior Aspect ◽  
Content Type ◽  
X Ray ◽  
Ligamenta Flava ◽  
Pyrophosphate Dihydrate

✓ Three cases of cervical myeloradiculopathy associated with multiple calcified nodules containing identified calcium pyrophosphate dihydrate (CPPD) crystals in the ligamenta flava are described, with a comprehensive review of the 12 cases of this entity reported to date. The disease is characterized by: 1) oval or triangular areas of radiodensity in the posterior aspect of the cervical canal as seen in the lateral x-ray films and laminograms; 2) hemispherical areas of high density located almost symmetrically in the paramedial portion of the posterior spinal canal on computerized tomography scans; and 3) CPPD crystals in the nodules. It occurs independently or in association with cervical spondylosis or ossification of the posterior longitudinal ligament.

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.

Foramen magnum syndrome from pseudogout of the atlanto-occipital ligament

1989 ◽  
Vol 71 (1) ◽  
pp. 141-143 ◽  
Author(s):  
Samuel F. Ciricillo ◽  
Philip R. Weinstein
Keyword(s):  
Posterior Longitudinal Ligament ◽  
Calcium Pyrophosphate ◽  
Foramen Magnum ◽  
Calcium Pyrophosphate Dihydrate ◽  
Transverse Ligament ◽  
Content Type ◽  
Pyrophosphate Dihydrate ◽  
Transoral Decompression ◽  
Calcium Pyrophosphate Dihydrate Crystals ◽  
Fine Print

✓ The authors report a case of progressive foramen magnum syndrome due to deposits of calcium pyrophosphate dihydrate crystals, which caused reactive hypertrophy in the posterior longitudinal ligament at C-1 and in the transverse ligament of the atlas in an 84-year-old woman. This is the first reported case of symptomatic pseudogout in this anatomic location. Rapid neurological recovery followed transoral decompression of the cervicomedullary junction.

scholarly journals Pseudogout of the Transverse Atlantal Ligament: An Unusual Cause of Cervical Myelopathy

2004 ◽  
Vol 31 (2) ◽  
pp. 273-275 ◽  
Author(s):  
Donald E.G. Griesdale ◽  
Mike Boyd ◽  
Ramesh L. Sahjpaul
Keyword(s):  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Healthy Woman ◽  
Cord Compression ◽  
Calcium Pyrophosphate ◽  
Craniocervical Junction ◽  
Upper Cervical Spine ◽  
Calcium Pyrophosphate Dihydrate ◽  
Upper Cervical ◽  
Pyrophosphate Dihydrate

AbstractBackground:Calcium pyrophosphate dihydrate deposition in the cervical spine is infrequently symptomatic. This is especially true at the craniocervical junction and upper cervical spine.Case Report:A 70-year-old previously healthy woman presented with a progressive cervical myelopathy of four months duration.Results:Examination revealed sensorimotor findings consistent with an upper cervical myelopathy. Radiological studies (plain radiographs, computed tomography, and magnetic resonance imaging) revealed C1-2 instability, and a well-defined extradural 3cm x 1cm retro-odontoid mass causing spinal cord compression. Transoral resection of the mass was performed followed by posterior C1-2 stabilization. Histological examination of the mass confirmed calcium pyrophosphate dihydrate deposition. Follow-up examination showed marked clinical and radiological improvement.Conclusion:Although uncommon, calcium pyrophosphate dihydrate deposition disease should be considered in the differential diagnosis of extradural mass lesions in the region of the odontoid.

scholarly journals Tophaceous pseudogout in a 12-year-old dog, with a review of applicable laboratory tests

2020 ◽  
Vol 32 (5) ◽  
pp. 727-732
Author(s):  
Brittani R. Henschen ◽  
Michael R. Lewin-Smith ◽  
Pamela J. Mouser ◽  
Hazel M. Jenkins ◽  
Stacy L. Strausborger ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Correct Diagnosis ◽  
Polarized Light ◽  
Giant Cells ◽  
Calcium Pyrophosphate ◽  
Calcium Pyrophosphate Dihydrate ◽  
Calcium Phosphorus ◽  
Pyrophosphate Dihydrate ◽  
The Right ◽  
Tophaceous Pseudogout

Pseudogout, also known as calcium pyrophosphate dihydrate (CPPD) deposition disease or chondrocalcinosis, is caused by crystalline deposits of CPPD within the extracellular matrix of articular hyaline cartilage and fibrocartilage, and within articular and periarticular connective tissue. Using a variety of laboratory techniques, we diagnosed pseudogout in the right hindlimb digit V of a 12-y-old Standard Poodle. Histologically, the joint, bone, tendon, and dermis were expanded and effaced by masses of mineralized, rhomboid crystals surrounded by macrophages, multinucleate giant cells, fibrous connective tissue, and chondroid and osseous matrix. Rhomboid crystals exhibiting weak-positive birefringence were identified under polarized light using a first-order red compensator filter. Scanning electron microscopy with energy-dispersive x-ray analysis (SEM-EDXA) revealed that the rhomboid crystals were composed of calcium, phosphorus, and oxygen. Fourier-transform infrared (FTIR) microspectroscopy confirmed the presence of calcium pyrophosphate. In dogs, tophaceous pseudogout, which was the variant of pseudogout in our case, occurs as a single, tumor-like periarticular mass that can be invasive and mimic neoplasia. Having ancillary confirmatory testing (SEM-EDXA and FTIR), particularly in unusual histologic scenarios, such as tophaceous pseudogout in dogs, is desirable for confirming the correct diagnosis, even though it is available only at certain reference centers. The pathogenesis of pseudogout is unknown.

scholarly journals Cervical myelopathy due to subaxial calcium pyrophosphate dihydrate (CPPD) deposition with simultaneous asymptomatic crowned dens syndrome: two case reports

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Dong-Gune Chang ◽  
Jong-Beom Park ◽  
Ho-Young Jung ◽  
Kyung Jin Seo
Keyword(s):  
Cervical Myelopathy ◽  
Cord Compression ◽  
Calcium Pyrophosphate ◽  
Calcium Pyrophosphate Dihydrate ◽  
Mri Findings ◽  
Decompressive Laminectomy ◽  
Plain Radiographs ◽  
Calcified Lesion ◽  
Crowned Dens Syndrome ◽  
Pyrophosphate Dihydrate

Abstract Background There are few reports of cervical myelopathy caused by an attack of subaxial calcium pyrophosphate dihydrate (CPPD) deposition. Moreover, there has been no report on cervical myelopathy by subaxial CPPD deposition with simultaneous asymptomatic crowned dens syndrome (CDS) at the same time. Case presentation The first case was a 68-year-old male complaining of cervical myelopathic symptoms. Plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) findings revealed spinal cord compression by calcified round lesions at C4 as well as a calcified lesion behind the dens. The second case was a 77-year-old female complaining of cervical myelopathic symptoms. Plain radiographs, CT and MRI findings revealed spinal cord compression by calcified round lesions at C3 and C4 as well as a calcified lesion behind the dens. In both cases, we believed that the calcified lesion behind the dens was an asymptomatic lesion. Therefore, the first patient received decompressive laminectomy of C3 and C4, removal of calcified round lesions, and posterior fixation from C3 to C5 due to associated kyphosis. The second patient underwent decompressive laminectomy of C3 and C4 and removal of calcified round lesions. Microscopic examination under polarized light showed dark blue calcifications with rhomboid crystals that were positively birefringent. The findings were consistent with those of CPPD. Conclusions This is the first study to report cervical myelopathy caused by subaxial CPPD deposition with simultaneous asymptomatic CDS. Surgical removal of the subaxial CPPD deposition alone achieved a satisfactory surgical outcome without recurrence.

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