Asian Spine J.  2015 Apr;9(2):286-289. 10.4184/asj.2015.9.2.286.

Pycnodysostosis with Multi-Segmental Spinal Canal Stenosis due to Ossification of the Yellow Ligament

• Wada K
• Kanaya K
• Murata Y
• Kato Y

• KMID: 2270174
• DOI: http://doi.org/10.4184/asj.2015.9.2.286

Abstract

Pycnodysostosis is an autosomal recessive disorder characterized by osteosclerosis, small stature, acro-osteolysis of the distal phalanges, loss of the mandibular angle, separated cranial sutures with open fontanels, and frequent fractures. One identified cause of the disease is reduced activity of the cysteine protease cathepsin K. A 48-year-old woman with a history of frequent fractures presented with a severe gait disturbance. Radiography, computed tomography, magnetic resonance imaging, and gene analysis were performed. Physical examination revealed open fontanels, and radiographs showed increased bone density. DNA sequence analysis revealed a deletion mutation of the cathepsin K gene. We diagnosed pycnodysostosis based on these findings. The magnetic resonance and computed tomography images demonstrated multilevel spinal canal stenosis due to ossification of the yellow ligament. We performed a laminectomy, and the patient's neurological signs and symptoms improved. To our knowledge, this is the first case of pycnodysostosis with ossification of the yellow ligament.

Keyword

Pycnodysostosis; Ossification of yellow ligament; Cathepsin K

MeSH Terms

Acro-Osteolysis
Bone Density
Cathepsin K
Constriction, Pathologic*
Cranial Sutures
Cysteine Proteases
Female
Gait
Humans
Laminectomy
Ligaments*
Magnetic Resonance Imaging
Middle Aged
Osteosclerosis
Physical Examination
Pycnodysostosis*
Radiography
Sequence Analysis, DNA
Sequence Deletion
Spinal Canal*
Cathepsin K
Cysteine Proteases