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.

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.

Foraminal deposition of calcium pyrophosphate dihydrate crystals in the thoracic spine: possible relationship with disc herniation and implications for surgical planning

2005 ◽  
Vol 2 (1) ◽  
pp. 75-78 ◽  
Author(s):  
Sergio Paolini ◽  
Pasquale Ciappetta ◽  
Antonio Guiducci ◽  
Massimo Principi ◽  
Paolo Missori ◽  
...  
Keyword(s):  
Surgical Planning ◽  
Calcium Pyrophosphate ◽  
Herniated Disc ◽  
Calcium Pyrophosphate Dihydrate ◽  
Posterior Aspect ◽  
Crystal Deposition ◽  
Content Type ◽  
Disc Herniations ◽  
Pyrophosphate Dihydrate ◽  
Fine Print

✓ The authors report two cases of nodular calcium pyrophosphate dihydrate (CPPD) crystal deposition close to the thoracic neural foramen, which caused chronic radiculopathy. Preoperatively, the lesions were interpreted as calcified disc herniations. Both patients underwent surgery in which an extended transfacet pedicle-sparing approach was used. Incision of the posterior longitudinal ligament released soft degenerated material. In both cases, histological examination showed abundant degenerative debris along with CPPD crystals. Spinal CPPD deposition is a comparatively rare disease that almost invariably involves the posterior aspect of the spinal canal, typically the ligamentum flavum. The exceptional foraminal location of the lesions reported here, combined with the surgical findings, indicated that the CPPD crystals were deposited on a laterally herniated disc fragment. A distinctive feature in both cases was the soft consistency of the resected tissue. The consistency of the disc material and the location of the lesion in the axial plane (that is, median compared with lateral) are key factors in determining the optimal surgical approach to thoracic disc herniations. In describing consistency, terms such as “calcified” and “hard” have been used interchangeably in the literature. In the cases reported here, what appeared on computerized tomography and magnetic resonance imaging studies to be densely calcified lesions were shown intraoperatively to be soft herniations. The authors' experience underscores that not all densely calcified herniated discs are hard. Although detection of this discrepancy would have left surgical planning for the lateral disc herniations unchanged, it could have altered planning for centrally or centrolaterally located disc herniations.

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.

Deposition of calcium pyrophosphate dihydrate crystals in the hand

1988 ◽  
Vol 13 (6) ◽  
pp. 943-948 ◽  
Author(s):  
Koichiro Ishikawa ◽  
Issei Higashi ◽  
Yoshifumi Shimomura ◽  
Kensuke Yonemura
Keyword(s):  
Calcium Pyrophosphate ◽  
Calcium Pyrophosphate Dihydrate ◽  
Pyrophosphate Dihydrate ◽  
Calcium Pyrophosphate Dihydrate Crystals

Cervical myelopathy due to ossification of the posterior longitudinal longitudinal ligament

1972 ◽  
Vol 37 (6) ◽  
pp. 653-660 ◽  
Author(s):  
Chikao Nagashima
Keyword(s):  
Cervical Myelopathy ◽  
Posterior Margin ◽  
Posterior Longitudinal Ligament ◽  
Foramen Magnum ◽  
Primary Lesion ◽  
Foramen Magnum Decompression ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Longitudinal Strip ◽  
Fine Print

✓ Ten patients who had cervical myelopathy due to ossification of the posterior longitudinal ligament of the cervical spine are described. This disease is characterized by an abnormal longitudinal strip of ossified ligamentous tissue along the posterior margin of vertebrae from C-3 to C-6; the primary lesion appears to be a degeneration of the intervertebral disc. This distinct clinical, radiological, and pathological entity should be included in the differential diagnosis of cervical myelopathy. All 10 patients were treated by extensive decompressive laminectomy and multiple bilateral facetectomies, with or without foramen magnum decompression. The results were favorable, and postoperative myelography demonstrated dorsal migration of the entire dural contents.

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