Calcium Pyrophosphate Dihydrate Crystal Deposition of Multiple Lumbar Facet Joints: A Case Report

Namazie, Mohamed Ridzwan bin Mohamed; Fosbender, Murray R

doi:10.1177/230949901202000225

Cited by 9 publications

(20 citation statements)

References 15 publications

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“…Spinal CPPD is uncommon, and often resembles more common spine pathologies causing pain and neural compression [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Previous reports of spinal CPPD have typically involved the cervical and lumbar spines [17][18][19][20][21][22][23][24][25][26]. Here, we present two unusual cases of CPPD of the cervical and thoracolumbar spines.…”

Section: Introductionmentioning

confidence: 96%

Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: A report of two cases

Moon

Mabry

Pittman

2020

North American Spine Society Journal (NASSJ)

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Background: Spinal calcium pyrophosphate deposition disease (CPPD) is uncommon, and often resembles more common spine pathologies causing pain and neural compression. Here, we present two unusual cases of CPPD of the cervical and thoracolumbar spines. Case description: Case 1: A 71-year old female smoker presented with a large epidural mass causing rapidly progressive cervical myelopathy with weakness in the upper and lower extremities.Case 2: A 66-year-old morbidly obese male presented with chronic back pain for several years associated with progressively worsening radicular pain in his left lower extremity. Outcome: The first case is an example of tumoral CPPD involving the facet joint and expanding into the epidural space. The second case was an example of CPPD involving a thoracolumbar facet cyst, resulting in unilateral radiculopathy. Both patients were treated surgically and had significant improvement in symptoms postoperatively. Conclusions: CPPD in the spine is an uncommon diagnosis but should be considered in the differential diagnosis of patients presenting with back pain and associated neurological symptoms. Accurate diagnosis of spinal CPPD is important in that it will guide postoperative management with anti-inflammatory medications and reduce risk of recurrence.

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Section: Introductionmentioning

confidence: 96%

Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: A report of two cases

Moon

Mabry

Pittman

2020

North American Spine Society Journal (NASSJ)

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“…J Orthop Surg (Hong Kong) 2012;20:254–6. 11 2012 Case report (1) Woman, 69 years One-year history of low back pain that had increased over the past 2 months Neurological Examination Inflammatory markers X ray CT scan MRI Histology (open spinal decompression) Normal slightly raised, with a C-reactive protein level of 15 mg/l (reference range, 0–4 mg/l) and erythrocyte sedimentation rate of 46 mm/h (reference range, 0–20 mm/h). Hypertrophic degenerative changes of the facet joints of L4-L5 and L5-S1, and a grade-one spondylolisthesis of L4 on L5.…”

Section: Resultsmentioning

confidence: 99%

“… 17 , 20 , 22 , 23 Five patients had more than two comorbidities including diabetes, hypertension, coronary artery disease, hypothyroidism, gout, prostate cancer, stomach, and cervical tumor. 8 , 11 , 14 , 18 , 24 , 25 …”

Section: Resultsmentioning

confidence: 99%

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Lumbar Spinal Involvement in Calcium Pyrophosphate Dihydrate Disease: A Systematic Literature Review

Tekaya¹,

Nacef²,

Bellil³

et al. 2022

IJGM

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Background Calcium-pyrophosphate-dihydrate-disease (CPPD) is a crystal-induced arthropathy. The lumbar-spinal involvement is rare and often under-diagnosed. This study aimed to report the case of a lumbar spine CPPD involvement and to perform a systematic review of clinical, imaging features of lumbar involvement in CPPD patients, and treatments that have been implemented. Methods This systematic review was conducted in accordance with the Preferred-Reporting-Items-for-Systematic-Reviews and Meta-Analyses (PRISMA) guidelines. Results One hundred and sixty-seven articles met the search criteria using electronic databases searches. We retained 28 articles (20 case reports, 2 case series, 1 family survey, 4 retrospective studies, and 1 prospective study) involving a total of 62 patients. The age ranged between 39 and 89 years old. Among patients with lumbar spine CPPD, 32 were women. The duration of symptoms varied between one day and 8 years. The affection has been discovered during back pain in most cases. In 5 studies, the diagnosis was made on histological specimens of patients operated on for another pathology. X-ray showed calcifications in 2 cases. CT-scan detected calcium deposit in 7 cases. MRI showed lesions going from the increased signal of the disk, to calcified or not-cystic lesion of the facet joints, an intramedullary mass mimicking a schwannoma. Histological examination established the diagnosis of CPPD in 21 patients in all studies. Medical treatment included NSAIDs, Colchicine, Interleukin-1-receptor-antagonist, and antibiotics. Surgery was performed on 13 patients and allowed to establish the histological diagnosis. Conclusion In the case of inflammatory back pain in elderly subjects, without an infectious gateway, diagnosis of CPPD should be considered, especially for patients with a history of spinal surgery or degenerative radiography changes. CT scan is more sensitive than conventional radiographs. The discovertebral biopsy is the Gold-Standard and should be performed whenever the diagnosis was uncertain. Treatment includes the medical and surgical components.

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“…In a search of clinical articles, based on PubMed, since the year 2000, only a few case reports [ 5 , 7 , 8 , 10 , 12 , 13 ] of CPPD crystal deposition involving the lumbar spine were found. Specifically, only 2 case reports described acute CPPD crystal arthritis of the lumbar spine ( Table 1 ) [ 8 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Attack of Pseudogout with the Wide Lesion in Lumbar Spondylolytic Spondylolisthesis

Kaneyama

Morishita

Kawano

et al. 2020

Case Reports in Orthopedics

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Objective. To report a rare case of an acute attack of calcium pyrophosphate dihydrate (CPPD) deposition disease in a patient with lumbar spondylolytic spondylolisthesis, which demonstrated widespread lesion with neurological deficit. Methods. An 86-year-old woman presented with high fever and bilateral neurological deficit of the lower extremities. Results. CRP was elevated (20.9 mg/dl). Plain radiographs and computed tomography images showed bilateral L4 spondylolytic spondylolisthesis. Sagittal magnetic resonance (MR) images revealed effusion at the L3-4 interspinous space, and a gadolinium- (GD-) enhanced epidural mass was observed at the level of L4 vertebral body. Axial MR images showed an intra- or epidural lesion at L2-3. Moreover, epidural GD-enhanced masses compressed the dural sac in the shape of a cross at the L3-4 and L4-5 segments. The patient was suspected of having pyogenic arthritis of the lumbar spine in initial diagnosis. A total of 1.2 ml of fluid with a murky, pus-like synovial effusion was aspirated from the L3-4 interspinous space under the fluoroscopic image. Smear speculum of synovial fluid tested negative for bacteria and fungi; however, a number of crystals were seen. Based on the result of smear speculum, we suspected the pathology as crystal deposition disease. Based on polarized light microscopy, which revealed monocle or triclinic intracellular crystals with a positive birefringence, the patient was diagnosed with pseudogout of the lumbar spine. Nonsteroidal anti-inflammatory drugs (NSAIDs) were administered by intravenous drip injection for 3 days, and local and systemic inflammatory signs, as well as neurological deficits, dramatically improved. Conclusions. We encountered the rare case of an acute attack of pseudogout with the wide lesion in the lumbar spondylolytic spondylolisthesis. Multiple culture of the effusion provided a definitive diagnosis, which allowed for appropriate, minimally invasive treatment for 8 weeks of NSAID administration that provided the satisfactory recovery from the symptoms.

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Calcium Pyrophosphate Dihydrate Crystal Deposition of Multiple Lumbar Facet Joints: A Case Report

Cited by 9 publications

References 15 publications

Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: A report of two cases

Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: A report of two cases

Lumbar Spinal Involvement in Calcium Pyrophosphate Dihydrate Disease: A Systematic Literature Review

Acute Attack of Pseudogout with the Wide Lesion in Lumbar Spondylolytic Spondylolisthesis

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