Cervical spine and crystal-associated diseases: imaging findings

Abstract

The cervical spine may be specifically involved in crystal-associated arthropathies. In this article, we focus on the three common crystals and diseases: hydroxyapatite crystal deposition disease, calcium pyrophosphate dihydrate (CPPD) deposition disease, and monosodium urate crystals (gout). The cervical involvement in crystal-associated diseases may provoke a misleading clinical presentation with acute neck pain, fever, or neurological symptoms. Imaging allows an accurate diagnosis in typical cases with calcific deposits and destructive lesions of the discs and joints. Most of the cases are related to CPPD or hydroxyapatite crystal deposition; gout is much less common.

An Unusual Cause of the Neck-Tongue Syndrome

“…Hence, the most plausible diagnosis in our patient with an erosive arthropathy would be erosive osteoarthritis or crystal arthropathy associated with nodal osteoarthritis. Between these 2 plausible causes, crystal arthropathy secondary to calcium pyrophosphate deposition disease (CPPD) has been described in the literature as causing extensive erosive changes, bony sclerosis, osteophyte formation, and a pseudo-Charcot type appearance in the cervical spine, particularly at the craniocervical junction, very similar to the findings in our case 4 . Hydroxyapatite deposition disease, gout, and erosive osteoarthritis usually do not present with such extensive radiological changes involving the cervical spine.…”

Intervertebral chondrocalcinosis: an exercise in differential diagnosis in palaeopathology

“…The distinction between CPPD and HADD is complicated by the observation that the two may co-exist as mixed calcium phosphate crystal deposition disease (Hayes & Conway, 1990), and the Milwaukee shoulder may represent a severe form of mixed disease (Halversen et al, 1984;Reginato & Reginato, 2001). That discal calcifications are not common in HADD, whereas calcification at tendinous and ligamentous insertions are common and prominent features (Hayes & Conway, 1990;Feydy et al, 2006), argues against this diagnosis for the current case.…”

“…HADD is a common condition in which there are deposits of basic calcium phosphate crystals in peri-articular tissues and, less commonly, in intra-articular structures, including the intervertebral discs (Dalinka et al, 1982;Hayes & Conway, 1990;Feydy et al, 2006). Like CPPD, it may occur secondary to other metabolic disorders but more commonly presents as a primary idiopathic condition (Reginato & Reginato, 2001).…”

Crowned Dens Syndrome

“…It can occur within various soft tissues, such as cartilage, joint capsules, synovium, bursae, tendons, and ligaments 3 . The idiopathic form is the most common and the prevalence of the condition increases with age 4 . However, there are rare familial forms.…”

“…The appearance of crystals may induce inflammation, as multiple protein molecules can adsorb onto their surface, leading to formation of a crystal-protein complex. Then the crystal is taken into the neutrophil via endocytosis in an attempt at degradation, but this has an opposite effect, which results in a release of proteolytic enzymes and ultimately cell death 4 . Crystal deposition disease specifically involves the cervical spine around the odontoid process, including the synovial membrane, articular capsule, transverse ligament, and transverse cruciate and alar ligaments 4,5 .…”