Abstract
Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is characterized by the accumulation of CPPD crystal in articular and periarticular tissues, but CPPD crystal deposition along the spinal dura mater has not been previously reported. We report a 54-year-old male presenting with progressive neck pain and numbness of the extremities. CT showed diffuse dorsal epidural calcification from C3-T6 which resulted in spinal canal stenosis. On MR imaging, the lesion was hypointense on both T1 and T2 weighted images. From these findings, CPPD crystal deposition in the ligamentum flavum was suspected preoperatively. Biopsy at the level of C5-6 were performed to confirm the diagnosis. Perioperative and histopathological findings revealed that CPPD crystals were deposited along the dorsal dura mater, not in the ligamentum flavum. We firstly report the CT and MR imaging features of a possible new concept in the differential diagnosis of CPPD crystal deposition disease.
Highlights
Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is characterized by the accumulation of CPPD crystals in articular and periarticular tissues.[1,2,3]
CPPD crystal deposition disease is found in 9.6% of individuals older than 50 years, and this incidence increases with age.[3]
Both aging and osteoarthritis are independently associated with CPPD crystal deposition
Summary
Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is characterized by the accumulation of CPPD crystals in articular and periarticular tissues.[1,2,3] CPPD crystal deposition can present with acute arthritis or chronic arthropathy with structural changes of osteoarthritis. CPPD crystal deposition disease of the spine is less common, it can involve the ligamentum flavum; longitudinal, supraspinous and interspinous ligaments; the intervertebral discs, and the sacroiliac and apophyseal joints.[2] CPPD crystal deposition along the dorsal spinal dura mater has not been previously reported.
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