Calcium pyrophosphate dihydrate deposition in the transverse ligament of the atlas: an unusual cause of cervical myelopathy

• Published in: Skeletal radiology Vol. 36; no. 7; pp. 699 - 702
• Main Authors: Doita, M., Shimomura, T., Maeno, K., Nishida, K., Fujioka, H., Kurosaka, M.
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01.07.2007; Springer Nature B.V
• Subjects: Aged; Biological and medical sciences; Calcification; Calcium; Central nervous system diseases; Cervical Atlas - diagnostic imaging; Cervical Atlas - pathology; Cervical Atlas - surgery; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - pathology; Chondrocalcinosis; Chondrocalcinosis - complications; Chondrocalcinosis - diagnosis; Chondrocalcinosis - surgery; Computed tomography; Crystals; Dehydration; Deposition; Diagnosis, Differential; Differential diagnosis; Diseases of the osteoarticular system; Humans; Hypesthesia - etiology; Image enhancement; Ligaments - diagnostic imaging; Ligaments - pathology; Ligaments - surgery; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical imaging; Medical sciences; Medical treatment; Miscellaneous. Osteoarticular involvement in other diseases; Muscle Weakness - etiology; Older people; Paresthesia - etiology; Pyrophosphates; Rare Diseases; Signs and symptoms; Spinal cord; Spinal Cord Compression - diagnosis; Spinal Cord Compression - etiology; Tomography, X-Ray Computed - methods; Treatment Outcome; Cervical myelopathy; Chondrocalcinosis; Radiodiagnosis; Diseases of the osteoarticular system; Transverse ligament; Calcium phosphate; Craniocervical junction; Nuclear magnetic resonance imaging; Extradural; CT; Myelopathy; Chondropathy; Calcium phosphate dihydrate; Pseudogout; Medical imagery; Atlas(bone); Computerized axial tomography; Odontoid process
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-006-0273-3

A 75-year-old male presented with progressive myelopathy due to massive retro-odontoid deposits of calcium pyrophosphate dehydrate (CPPD) crystals. Magnetic resonance imaging revealed a non-enhanced isointense extradural mass on a T1-weighted image and a heterogeneous intense mass on a T2-weighted image. Computed tomography (CT) showed linear calcification within the mass. The mass was resected via a posterolateral approach resulting in marked improvement of the symptoms. Histological examination revealed birefringent rhomboid crystals consistent with CPPD. The preoperative differential diagnosis of periodontoid CPPD deposition disease in the elderly population should be considered, particularly if CT studies demonstrate small areas of calcification within the retro-odontoid mass.