Calcium pyrophosphate dihydrate crystal deposition disease in the cervical ligamentum flavum

Abstract

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.

Cervical spine and crystal-associated diseases: imaging findings

“…CPPD crystal deposition can be seen in several spinal structures, including intervertebral discs, joint capsules, synovium, articular cartilage, bursae, and ligaments [5,[15][16][17][18][19][20][21]. All spinal bursae and ligaments may be involved.…”

Pseudogout Showing Meningoencephalitic Symptoms: Crowned Dens Syndrome

“…Severe neck pains and occipitalgia sometimes occur in patients with hydoxyapatite (HA) and calcium pyrophosphate dehydrate (CPPD) crystal deposition diseases (1,2). The crowned dens syndrome has been commonly termed as acute neck pain attributed to HA and/or CPPD depositions surrounding the odontoid process (3)(4)(5).…”

Brown-Sequard syndrome caused by ossification of the ligamentum flavum

“…4,8 Bone marrow can develop in rare cases. 9 Calcification of the ligamentum flavum, which is another entity defined by many authors [8][9][10][11][12] occurs most frequently in the cervical spine and is diagnosed via detection of crystals of calcium pyrophosphate dihydrate or calcium hydroxyapatite within the ligamentum flavum without mature bone formation. In our patient, endochondral ossification was identified without any crystal formation; thus, diagnosis of OLF was straightforward.…”