Journal List > J Korean Soc Spine Surg > v.14(2) > 1035798

Lee, Hwang, Kim, and Shin: Calcium Pyrophosphate Dihydrate Crystal Deposition Disease in the Cervical Ligamentum Flavum - A Case Report -

Abstract

Calcium pyrophosphate dihydrate deposition disease (CPPD) is an inflammatory arthropathy that is defined by the deposition of CPPD crystals in articular and periarticular structures. The cervical ligamentum flavum is a rare location of CPPD deposition. A 65-year-old woman was admitted with complaints of neck pain and a tingling sensation and numbness below the xiphoid process for 2 months. Magnetic resonance (MR) imaging and computed tomography (CT) revealed compression of the spinal cord due to a nodular calcified mass in or attached to the ligamentum flavum at the C4-5, C5-6, or C6-7 level. The patient underwent a laminectomy at C4-5, C5-6, and C6-7, and resectioning of calcified extradural nodules that impinged on the cervical cord. The operation resulted in a resolution of neck pain and hypoesthesia, except in the feet. Histopathological examination of the excised specimen revealed rectangular CPPD crystals. Here, we report a case of compressive cervical spine due to CPPD deposition disease of the cervical spine and describe the literature relevant to CPPD deposition disease of the cervical spine.

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Fig. 1.
Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease in a 65-year-old woman with a history of neck pain and numbness below xiphoid process. Plain radiographs show dense and homogenous radiopaque deposits (arrows indicated) at C6-7 level in AP view (A) and lateral view (B).
jkss-14-96f1.tif
Fig. 2.
Computed tomographic scan showing nodular calcified deposits in the ligamentum flavum at C6-7.
jkss-14-96f2.tif
Fig. 3.
T2-weighted sagittal MR images showing a hypointense mass compressing the cervical cord at C6-7, C5-6, C4-5 levels.
jkss-14-96f3.tif
Fig. 4.
Photomicrography showing multiple CPPD crystals (arrow indicated) in fibrocollagenous stroma with numerous giant cells. (H & E stain; ×100)
jkss-14-96f4.tif
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