P14. Cervical spine pseudogout mimicking ossification of posterior longitudinal ligament: a case report and literature review

Abstract

BACKGROUND CONTEXT

Calcium pyrophosphate deposition (CPPD) disease, often termed pseudogout, commonly involves peripheral joints, but cervical spine manifestations are rare. When CPPD affects the cervical spine, crystal deposition in ligaments and intervertebral discs can lead to spinal cord or nerve root compression, resulting in significant myelopathy or radiculopathy. Because these presentations often mimic more common degenerative conditions (eg, ossification of the posterior longitudinal ligament), accurate diagnosis is crucial for effective treatment.

PURPOSE

To describe a rare case of cervical CPPD with widespread ligamentous and disc involvement that mimicked ossification of the posterior longitudinal ligament, emphasizing the importance of early recognition and appropriate surgical intervention to prevent irreversible neurologic deficits.

STUDY DESIGN/SETTING

Single-patient case report treated at a tertiary neurosurgical center, with a review of relevant literature on cervical spine CPPD.

PATIENT SAMPLE

A 69-year-old female presenting with progressive neck pain, radiating right arm pain, hand numbness, gait imbalance, and frequent falls over a two-year period.

OUTCOME MEASURES

Neurological function (including strength, reflexes, and gait), pain relief, and imaging studies (CT/MRI) before and after surgical intervention.

METHODS

Comprehensive preoperative imaging (CT/MRI) revealed extensive cervical calcifications in the ligamentum flavum, posterior longitudinal ligament, and intervertebral discs, causing multilevel spinal cord compression. The patient underwent combined anterior and posterior decompression with instrumented fusion. Pathological examination of resected tissues confirmed CPPD through identification of positively birefringent crystals under polarized light. Postoperative follow-up was conducted to assess neurological recovery and possible peripheral joint involvement.

RESULTS

The patient’s numbness and gait instability improved significantly following decompression and fusion, and no cervical recurrence was noted at two-year follow-up. Persistent right shoulder pain was subsequently attributed to possible CPPD in the supraspinatus tendon, highlighting the multifocal nature of the disease.

CONCLUSIONS

Cervical CPPD can mimic other degenerative spinal pathologies and, if unrecognized, may lead to severe neurological compromise. Early identification through imaging and histopathological confirmation is critical. Surgical decompression can yield favorable outcomes, and ongoing vigilance for CPPD in peripheral joints is recommended due to its potential multifocal presentation.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.