Compressive Cervical Myelopathy Due to Calcium Pyrophosphate Dihydrate Deposition Disease

Abstract

Calcium pyrophosphate dihydrate (CPPD) deposition disease is an inflammatory arthropathy that is defined by the deposition of CPPD crystals in articular and periarticular structures. The deposition of CPPD in hyaline cartilage and fibrocartilage leads to the chondrocalcinosis that is characteristic of the disease. It can occur independently or in association with any of a number of inflammatory or endocrine disorders. This form of crystal-induced arthritis tends to affect the peripheral joints, particularly the knees, ankles, shoulders, wrists, and second and third metacarpophalangeal joints, but involvement of the lumbar spine is not uncommon. Cervical spine disease due to CPPD deposition is, however, rare. We report a case of compressive cervical myelopathy due to CPPD deposition disease of the cervical spine in a woman with long-standing rheumatoid arthritis. We also, from a review of the English-language literature, describe the collective reported clinical experience with CPPD deposition disease of the cervical spine.

Cervical spine and crystal-associated diseases: imaging findings

“…Fewer than 30 cases have been reported in the English- language literature [26]; the C3 through C7 levels appear to be most commonly involved (Fig. 6c).…”

The crowned dens syndrome as a cause of neck pain: Report of two new cases and review of the literature

“…Less commonly, pyrophosphate tophaceous deposits have been observed around peripheral joints and in the spine, including the intervertebral disc, posterior longitudinal ligament, facet joints, ligamentum flavum, and sacroiliac joint (7)(8)(9). In the cervical spine, calcified deposits in the ligamentum flavum, facet joints, lateral masses, and posterior longitudinal and atlantoccipital ligaments can be associated with signs of spinal stenosis, meningismus, and cervical myelopathy (9,10).…”

Diagnosis of Calcium Pyrophosphate Dihydrate Deposition Disease by Fine Needle Aspiration Biopsy

“…The disease may be asymptomatic or present, more commonly, as osteoarthritis 2 or compression myelopathy. 3 A severe pathologic reaction to calcium pyrophosphate dihydrate deposition may cause bone erosion and soft tissue swelling, mimicking osteomyelitis or metastatic carcinoma. 4,5 While fine needle aspiration biopsy (FNAB) is well accepted to the diagnosis of many superficial and deep lesions, FNAB can be utilized as a simple, cost-effective yet reliable method of diagnosing CPPD in suspicious cases.…”