J Korean Soc Spine Surg.  2007 Jun;14(2):96-100. 10.4184/jkss.2007.14.2.96.

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease in the Cervical Ligamentum Flavum: A Case Report

• Lee JC
• Hwang SH
• Kim YI
• Shin BJ

• KMID: 1941661
• DOI: http://doi.org/10.4184/jkss.2007.14.2.96

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.

Keyword

Calcium pyrophosphate dihydrate crystal deposition disease; Ligamentum flavum; Cervical spine

MeSH Terms

Aged
Calcium Pyrophosphate*
Calcium*
Chondrocalcinosis
Female
Foot
Humans
Hypesthesia
Laminectomy
Ligamentum Flavum*
Neck Pain
Sensation
Spinal Cord
Spine
Calcium
Calcium Pyrophosphate

Figure

• 

  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).

• 

  Fig. 2. Computed tomographic scan showing nodular calcified deposits in the ligamentum flavum at C6-7.

• 

  Fig. 3. T2-weighted sagittal MR images showing a hypointense mass compressing the cervical cord at C6-7, C5-6, C4-5 levels.

• 

  Fig. 4. Photomicrography showing multiple CPPD crystals (arrow indicated) in fibrocollagenous stroma with numerous giant cells. (H & E stain; ×100)

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