title: Calcium pyrophosphate dihydrate crystal deposition disease in the cervical ligamentum flavum.
abstract: The authors describe three cases of cervical radiculomyelopathy caused by calcium pyrophosphate dihydrate crystal deposition disease (CPPDcdd). Radiological investigations revealed nodular calcifications, 5 to 7 mm in diameter, in the cervical ligamentum flavum compressing the spinal cord. Light microscopic, scanning electron microscopic, and x-ray diffraction studies were performed on all three surgical specimens obtained by laminectomy. In two of the cases x-ray microanalysis and transmission electron microscope studies were also performed. This study defined the presence of two patterns of crystal deposition in the ligamentum flavum. One is a nodular deposit, in which hydroxyapatite crystals are seen in the central part of the nodules, with calcium pyrophosphate dihydrate (CPPD) being distributed thinly around them. The other pattern is a linear deposit seen in multiple ligaments and composed of pure CPPD, which causes minimal thickening of the ligaments. A transitional pattern between the two types was also observed. This study revealed details of the nodular deposition of crystals in the ligamentum flavum and demonstrates that CPPDcdd and so-called "calcification of the ligamentum flavum" are the same disease: namely, CPPDcdd. Hydroxyapatite is assumed to have been transformed from CPPD.
authors.affiliation: Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Kawano
authors.forename: T
authors.initials: T
authors.lastname: Matsuno
authors.forename: S
authors.initials: S
authors.lastname: Miyazawa
authors.forename: H
authors.initials: H
authors.lastname: Iida
authors.forename: K
authors.initials: K
authors.lastname: Yada
authors.forename: N
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Y
authors.initials: Y
authors.lastname: Iwasaki
mesh_terms: D000368:Aged; D002131:Calcium Pyrophosphate / Q000378:metabolism*; D002805:Chondrocalcinosis / Q000378:metabolism* / Q000473:pathology; D003460:Crystallization; D011756:Diphosphates / Q000378:metabolism*; D005260:Female; D006801:Humans; D008022:Ligaments / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000648:ultrastructure; D008297:Male; D008854:Microscopy, Electron; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D009333:Neck; D011859:Radiography; D013131:Spine / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000648:ultrastructure; D014961:X-Ray Diffraction
chemical_list: D011756:Diphosphates; D002131:Calcium Pyrophosphate