Spinal pseudogout is a joker. Commentary on “Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: A report of two cases”

Abstract

In this issue, Moon et al. provide a detailed report on two cases of Calcium pyrophosphate deposition disease (CPDD), causing compression of the spinal cord and conus medullaris requiring surgical decompression and reconstruction [[1]Moon A.S. Mabry S. Pittman J.L. Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: a report of two cases.North American Spine Society J (NASSJ). 2020; 3: 100026https://doi.org/10.1016/j.xnsj.2020.100026Abstract Full Text Full Text PDF Scopus (1) Google Scholar]. Both cases presented on elderly patients, with known advanced degenerative disease of the spine. In both cases the mass was likely forming from the facet joint and both cases presented with a combination of severe pain and symptoms of neural compression (in different degrees, causing alteration of the spinal cord motor tracts in one case and unilateral lower limb pain mimicking radiculopathy in the second one). Both patients gained full resolution of symptoms and neurological function after surgery. A number of cases of CPDD affecting the spine have been described in the literature, but most reports include one or few cases, which suggests that CPDD requiring surgery is relatively unfrequent. This is in contrast with the finding of high prevalence (as high as 25%) of deposits of calcium pyrophosphate in the cervical spine of patients with pseudogout affecting peripheral joints [[2]Moshrif A. Laredo J.D. Bassiouni H. et al.Spinal involvement with calcium pyrophosphate deposition disease in an academic rheumatology center: a series of 37 patients.Semin Arthritis Rheum. 2019; 48: 1113-1126https://doi.org/10.1016/j.semarthrit.2018.10.009Crossref PubMed Scopus (31) Google Scholar]. While the association of pseudogout with lumbar and cervical stenosis has been well described, some aspects of this condition deserve some attention. The prognosis of spinal canal decompression in patients with CPDD does not seem to be worse than that on patients with degenerative lumbar stenosis [[3]Ariyawatkul T. Pichaisak W. Chavasiri C. Vamvanij V. Wilartratsami S. Luksanapruksa P. The role of calcium pyrophosphate dihydrate deposition in the postoperative outcome of lumbar spinal stenosis patients.Asian Spine J. 2019; 13: 1001-1009https://doi.org/10.31616/asj.2018.0280Crossref PubMed Scopus (2) Google Scholar]. CPDD can also need to be distinguished from other spinal conditions, such as tumors [[4]Turaga S. Thomas M. Savy L. Schreiber B.E. Pseudogout or pseudolymphoma? Calcium pyrophosphate deposition disease of the cervical spine: a rare presentation and literature review.BMJ Case Rep. 2019; 12 (Published 2019 Dec 2)e231508https://doi.org/10.1136/bcr-2019-231508Crossref PubMed Scopus (6) Google Scholar], spinal infection [[5]Bridges K.J. Bullis C.L. Wanchu A. Than K.D. Pseudogout of the cervical and thoracic spine mimicking infection after lumbar fusion: case report.J Neurosurg Spine. 2017; 27: 145-149Crossref PubMed Scopus (12) Google Scholar], hematoma of the yellow ligament [[6]Cruz-Conde R. Berjano P. Buitron Z. Ligamentum flavum hematoma presenting as progressive root compression in the lumbar spine.Spine. 1995; 20: 1506-1509https://doi.org/10.1097/00007632-199507000-00012Crossref PubMed Scopus (42) Google Scholar]. One of the two cases in this report presented with severe spinal sagittal misalignment that might be related to either the spinal cord compression or inflammation of the facet joints, and resolved after surgery, which suggests that CPDD can also be misinterpreted as spinal deformity of functional nature [[7]Redaelli A. Berjano P. Aebi M. Focal disorders of the spine with compensatory deformities: how to define them.Eur Spine J. 2018; 27: 59-69https://doi.org/10.1007/s00586-018-5501-8Crossref PubMed Scopus (9) Google Scholar]. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Download .pdf (.12 MB) Help with pdf files Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: A report of two casesNorth American Spine Society Journal (NASSJ)Vol. 3PreviewSpinal 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. Full-Text PDF Open Access