Acute neck pain caused by pseudogout attack of calcified cervical yellow ligament: a case report

Abstract

BackgroundCalcification of the yellow ligament sometimes compresses the spinal cord and can induce myelopathy. Usually, the calcification does not induce acute neck pain. We report a case of a patient with acute neck pain caused by calcium pyrophosphate dihydrate in a calcified cervical yellow ligament.Case presentationA 70-year-old Japanese woman presented with acute neck pain. She had a moderately high fever (37.5 °C), and her neck pain was so severe that she could not move her neck in any direction. Computed tomography showed a high-density area between the C5 and C6 laminae suspicious for calcification of the yellow ligament. Magnetic resonance imaging showed intermediate-signal intensity on T1-weighted imaging and high-signal intensity on T2-weighted imaging surrounding a low-signal region on both T1- and T2-weighted imaging with cord compression. There was a turbid, yellow fluid collection in the yellow ligament at the time of operation. Histologically, calcium pyrophosphate dihydrate crystals were found in the fluid, and she was diagnosed as having a pseudogout attack of the yellow ligament.ConclusionsPseudogout attack of the cervical yellow ligament is rare, but this clinical entity should be added to the differential diagnosis of acute neck pain, especially when calcification of the yellow ligament exists.

Multilevel calcium pyrophosphate dihydrate deposition in cervical ligamentum flavum: clinical characteristics and imaging features

“…Literature has shown that acute neck pain could be caused by CPPD crystal-induced arthritis of the lateral atlantoaxial joint [ 17 ]. In addition, Kobayashi et al [ 18 ] reported a case with acute neck pain that resulted from CPPD attack of the cervical ligamentum flavum without facet arthritis. Although we can not conclude that neck pain in our case series is due to CPPD deposition in ligamentum flavum, acute neck pain should be considered a symptom for the diagnosis of CPPD deposition disease.…”

Acute exacerbation of cervical myelopathy caused by pseudogout of the cervical ligamentum flavum after cervical spinal cord injury: a case report

“…Acute neck pain and fever are often caused by crowned dens syndrome or by crystal-induced arthritis of the lateral atlantoaxial joint in the elderly [3]. We previously reported a case of acute neck pain caused by pseudogout attack of calcified cervical ligamentum flavum [3]. There have been some reports of spinal canal stenosis due to CPPD crystal deposition [4].…”

“…Aging is one of the risk factors for pseudogout, and the elderly population is rapidly increasing in Japan [2]. Calcification of the ligamentum flavum sometimes causes acute neck pain and compression of the spinal cord [3], which can induce myelopathy [4]. However, there are few reports of acute exacerbation of myelopathy due to a pseudogout attack of the cervical ligamentum flavum, and there are no reports of that after a cervical spinal cord injury.…”

Pseudogout or pseudolymphoma? Calcium pyrophosphate deposition disease of the cervical spine: a rare presentation and literature review

“…Spinal involvement of calcium pyrophosphate arthritis is uncommon but has been reported 4 5. CPP crystals have been found in many spinal structures, including the intervertebral discs, synovium, articular cartilage, bursae and ligaments.…”