Progressive thoracic myelopathy caused by spinal calcium pyrophosphate crystal deposition because of proximal junctional vertebral compression fracture after lumbopelvic fusion

Odate, Seiichi; Shikata, Jitsuhiko; Fujibayashi, Shunsuke; Hosaka, Naoki; Soeda, Tsunemitsu; Kimura, Hiroaki

doi:10.1007/s00586-012-2410-0

Cited by 9 publications

(10 citation statements)

References 28 publications

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“…1,2 By contrast, UIV fractures among PJFs can sometimes lead to the need for reoperation and severe symptoms. 7,8 Oe et al reported that 58 (18.2%) of 318 patients who underwent ASD surgery suffered UIV fractures within 1 year. 9 The mean UIV level was T9 (+2) in both the UIV fracture and non-fracture groups with no significant difference therefore, it is very important to prevent UIV fractures.…”

Section: Discussionmentioning

confidence: 99%

Longer Screws Can Reduce the Stress on the Upper Instrumented Vertebra With Long Spinal Fusion Surgery: A Finite Element Analysis Study

Narita²,

Hara³

et al. 2021

Global Spine Journal

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Study Design: A finite element analysis study. Objective: Of proximal junctional failure, upper instrumented vertebra (UIV) fracture can causes severe spinal cord injury. Previously, we reported that higher occupancy rate of pedicle screw (ORPS) at UIV prevented UIV fracture in adult spinal deformity surgery; we had not yet tested this finding using a biomechanical study. The purpose of present study was to measure the differences in loads on the UIV according to the length of PS and ORPS. Methods: We designed an FE model of a lumbar spine (L1-S1) using FE software. The PS was set from L2 to S1 and connected the rod. The FE model simulated flexion (8 Nm) to investigate the loads at UIV (L2) according to the length of the PS. There were 5 screw lengths examined: 40 (ORPS 36.4%), 45 (48.5%), 50 (66.7%), 55 (81.8%), and 60 mm (93.9%). Results: Stress with bending motion was likely to occur at the upper front edge of the vertebral body, the pedicles, and the screw insertion point. The maximum equivalent stress according to screw lengths of 40, 45, 50, 55, and 60 mm were 45.6, 37.2, 21.6, 13.3, and 14.8 MPa, respectively. The longer screw, the less stress was applied to UIV. No remarkable change was observed between the screw lengths of 55 and 60 mm. Conclusions: Increasing ORPS to 81.8% or more reduced the load on the UIV. To prevent UIV fracture, the PS length in the UIV should be more than ORPS 81.8%.

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Section: Discussionmentioning

confidence: 99%

Longer Screws Can Reduce the Stress on the Upper Instrumented Vertebra With Long Spinal Fusion Surgery: A Finite Element Analysis Study

Narita²,

Hara³

et al. 2021

Global Spine Journal

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“…That same year, Odate et al reported 6 cases of adjacent-segment CPPD deposition following thoracolumbopelvic fixation. 19 In all cases, the CPPD involvement was within or immediately adjacent to the surgical site, diagnosed by identification of CPPD and multinucleated giant cells within the liga-mentum flavum removed during the subsequent decompressive laminectomies. In contrast to these reports, in the present case the patient developed pseudogout at levels remote from the lumbar fusion, involving both cervical and thoracic elements.…”

Section: Discussionmentioning

confidence: 99%

Pseudogout of the cervical and thoracic spine mimicking infection after lumbar fusion: case report

Bridges

Bullis

Wanchu

et al. 2017

Journal of Neurosurgery: Spine

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Pseudogout is a form of acute calcium pyrophosphate deposition (CPPD) disease that typically afflicts the elderly. CPPD commonly involves larger joints, such as the knees, wrists, shoulders, and hips, and has been known to involve the spine.The authors report the case of a 66-year-old woman with a recent history of lumbar laminectomy and fusion who presented 5 weeks postprocedure with a clinical and radiographic picture consistent with multilevel skip lesions involving the cervical and thoracic spine, thoracic discitis, and epidural abscess. Serial blood cultures and repeat biopsy samples were sterile. Subsequent wrist and ankle erythema, pain, and swelling led to synovial fluid analysis, and pseudogout was diagnosed. She was treated with an interleukin-1 inhibitor with immediate symptom relief.To the authors’ knowledge, this is only the second report of spinal pseudogout presenting with a clinical and radiographic picture consistent with discitis and epidural abscess. This report is the first to report skip lesions of pseudogout occurring throughout the spine that are uniquely remote from a recent lumbar surgery.

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“…However, it is unclear what role these previous surgeries had in the development of CPPD. Although local trauma is a known risk factor for CPPD [39][40][41][42], our patient presented eight years after his previous spine surgeries. Ogawa et al reported the first case of acute lumbar spinal pseudogout occurring four weeks after spinal instrumentation [39] .…”

Section: Discussionmentioning

confidence: 87%

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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Progressive thoracic myelopathy caused by spinal calcium pyrophosphate crystal deposition because of proximal junctional vertebral compression fracture after lumbopelvic fusion

Cited by 9 publications

References 28 publications

Longer Screws Can Reduce the Stress on the Upper Instrumented Vertebra With Long Spinal Fusion Surgery: A Finite Element Analysis Study

Longer Screws Can Reduce the Stress on the Upper Instrumented Vertebra With Long Spinal Fusion Surgery: A Finite Element Analysis Study

Pseudogout of the cervical and thoracic spine mimicking infection after lumbar fusion: case report

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

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