Pseudogout, an unconventional imitator of the lumbosacral spine with associated chronic epidural hematoma: illustrative cases

Abstract

BACKGROUND Pseudogout, or calcium pyrophosphate dihydrate (CPPD) disease, is an inflammatory joint disease that most commonly involves the joints of the knees, ankles, and wrists. Pseudogout has also been known to involve the spine, especially the atlanto-occipital joint of the cervical spine, but there is limited documentation of its involvement in the lumbar spine. Though the atypical presentation of spinal pseudogout with findings consistent with discitis and epidural abscess has been documented, its presentation with associated chronic spinal epidural hematoma is a rare entity. OBSERVATIONS The authors present two separate cases of pseudogout involvement of the lumbar spine, one case presenting with a clinical and radiographic picture consistent with discitis and epidural abscess and the other with radiographic and operative findings consistent with a chronic epidural hematoma. LESSONS This case series demonstrates rare and atypical presentations of pseudogout within the lumbosacral spine.

Acute cervical epidural abscess with concurrent calcium pyrophosphate deposition after cervical spinal surgery: A case report

“…Literally reviewed, five cases of CPPD after the spinal surgery were reported, and the interval time after the surgical procedure ranged from 4 weeks to 8 years; however, acute onset within a week has not been reported [ Table 1 ]. [ 2 , 5 , 7 , 9 , 11 ] In addition, the mass occupied the epidural space at the C6 and C7 levels where the surgical manipulation was not performed, which either infection or crystal-induced inflammation could not explain. Whether the diagnosis was SEA or CPPD, the acute postoperative interval of 4 days before the onset of neurological symptoms and the level of the mass formation was atypical.…”

“…Laminectomy(L2-5), bilateral foraminotomy, TLIF with PLF(L4/5) 5 weeks Antibiotics, followed by biopsy and IL-1 inhibitor Jaffee S, et al 2022 [5] 75 / Female Radiculopathy, paresthesia L3/4, L4/5 Laminectomy(L4/5) 9 months laminectomy, foraminotomy (L3/4) Lam HY et al 2007 [7] 72 / Female Buttock pain, lower limb numbness L4/5 L5 hemilaminectomy 2 years Removal Moon AS, et al 2020 [9] 66 /Male Back pain, radicular pain T12-L1 LIF (L1/2) with PLF (L1-3), sacro-iliac fusion, ACDF(C5-7)…”