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

BMC Musculoskeletal Disorders

Yueh-Hsiu Lu¹  Shih-Tien Wang²  Chien-Lin Liu²  Po-Hsin Chou²  Hsi-Hsien Lin²  Ming-Chau Chang²  Hsuan-Ying Chen³ 

[1] Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, 11217, Taipei, Taiwan, Republic of China;Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changhua County, 500054, Changhua, Taiwan, Republic of China;Institute of Biomedical Sciences, College of Life Sciences, National Chung Hsing University, No. 145 Xingda Rd., South District, 40227, Taichung, Taiwan, Republic of China;Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, 11217, Taipei, Taiwan, Republic of China;School of Medicine, National Yang-Ming University, No.155, Sec. 2, Linong St., Beitou Dist, 11217, Taipei City, Taiwan, Republic of China;Orthopedics & Sports Medicine Laboratory, Changhua Christian Hospital, No. 235 Shi-Guan Rd., Changhua County, 50006, Changhua, Taiwan, Republic of China;

关键词: Calcium pyrophosphate dihydrate;    Cervical ligamentum flavum;    Magnetic resonance imaging;    Ossification of ligamentum flavum;   

DOI  :  10.1186/s12891-021-04812-6

来源: Springer

【 摘 要 】

BackgroundInvolvement in cervical ligamentum flavum is a rare manifestation of the calcium pyrophosphate dihydrate deposition disease. Only few cases of this condition have been reported. We revealed eighteen cases of CPPD in cervical ligamentum flavum that diagnosed at a single medical center. In our case series, clinical characteristics and magnetic resonance imaging findings of patients are described.MethodsWe retrospectively reviewed the medical charts and imaging studies of the eighteen patients with pseudogout attack of the cervical ligamentum flavum. In addition, we discussed the differences between this disease and ossification of ligamentum flavum in image manifestations.ResultsThere were fourteen men and four women aged between 59 and 87 years. Diabetes mellitus and hypertension were the most common comorbidities. Myelopathy and neck pain were presented in most patients. C4–5 and C5–6 were attacked most frequently, and multiple- rather than single-level involvement could be observed in our series. “Acute on chronic phenomenon” was a specific magnetic resonance image finding in patients whose symptom durations were between 2 to 5 months. Compared to ossification of ligamentum flavum, calcium pyrophosphate dihydrate crystal deposition had different image signs, including morphology, side of the involved ligament, no continuity with the lamina, acute on chronic phenomenon, and presence of retro-odontoid mass.ConclusionsNodular calcifications in cervical ligamentum flavum raise highly suspicion for calcium pyrophosphate dihydrate deposition and must be diagnosed by histological examination and polarized light microscopy. This disease is different from ossification of ligamentum flavum, and it could be recognized by specific image features.

【 授权许可】

CC BY