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Clinical Observation |

Compressive Cervical Myelopathy Due to Calcium Pyrophosphate Dihydrate Deposition Disease:  Report of a Case and Review of the Literature

Kenneth H. Fye, MD; Philip R. Weinstein, MD; Fiona Donald, MD
Arch Intern Med. 1999;159(2):189-193. doi:10.1001/archinte.159.2.189.
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Calcium pyrophosphate dihydrate (CPPD) deposition disease is an inflammatory arthropathy that is defined by the deposition of CPPD crystals in articular and periarticular structures. The deposition of CPPD in hyaline cartilage and fibrocartilage leads to the chondrocalcinosis that is characteristic of the disease. It can occur independently or in association with any of a number of inflammatory or endocrine disorders. This form of crystal-induced arthritis tends to affect the peripheral joints, particularly the knees, ankles, shoulders, wrists, and second and third metacarpophalangeal joints, but involvement of the lumbar spine is not uncommon. Cervical spine disease due to CPPD deposition is, however, rare. We report a case of compressive cervical myelopathy due to CPPD deposition disease of the cervical spine in a woman with long-standing rheumatoid arthritis. We also, from a review of the English-language literature, describe the collective reported clinical experience with CPPD deposition disease of the cervical spine.

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A, Sagittal magnetic resonance image of the occipital atlantoaxial segments. The C2 body (asterisk) is normal. Degenerative alterations of the bone and bone marrow are evident in the odontoid process (black spots). An 8- to 10-mm-thick soft tissue mass in the posterior longitudinal ligament displaces the spinal cord at the cervical-medullary junction. The mass extends into the atlanto-occipital membrane at the caudal tip of the clivus. B, Sagittal T1-weighted image demonstrating the cystic component of the mass (arrow) and anterior subluxation of the posterior arch of C1. C, Sagittal T2-weighted image documenting severe central spinal stenosis with obliteration of the subarachnoid space at C1. Increased signal intensity within the cord (arrows) is due to edema or contusion.

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