Progressive thoracic myelopathy caused by spinal calcium pyrophosphate crystal deposition because of proximal junctional vertebral compression fracture after lumbopelvic fusion.
OBJECTIVE
We describe cases presenting with progressive thoracic myelopathy after lumbopelvic fusion attributed to proximal junctional vertebral compression fracture (PJF) followed by spinal calcium pyrophosphate dehydrate (CPPD) crystal deposition.


METHODS
The study included six patients, ranging from 62 to 75 years. All patients had been treated previously with lumbopelvic fusion. The mean period from the detection of PJF to the onset of myelopathy was 4.8 months. Notably, five patients demonstrated upper-instrumented vertebra (UIV) collapse.


RESULTS
After revision surgery involving decompressive laminectomy and extension of the spinal fusion, all patients experienced significant improvement. Photomicrographs of the resected ligamentum flavum showed CPPD crystals and multinucleated giant cells.


CONCLUSIONS
The combination of mechanical stress plus PJF and CPPD crystal deposition followed by a foreign body reaction to the deposited crystals caused myelopathy. Patients with radiographic evidence of PJF, especially UIV collapse, after lumbopelvic fusion should be followed carefully for the emergence of myelopathy.
Department of Orthopaedic Surgery, Spine Center, Gakkentoshi Hospital, 7-4-1 Seikacho, Seikadai, Sorakugun, Kyoto, Japan. s-odate@iseikai.jp
Seiichi
S
Odate
Jitsuhiko
J
Shikata
Shunsuke
S
Fujibayashi
Naoki
N
Hosaka
Tsunemitsu
T
Soeda
Hiroaki
H
Kimura
D000368:Aged; D002131:Calcium Pyrophosphate / Q000378:metabolism*; D005260:Female; D050815:Fractures, Compression / Q000209:etiology*; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology; D012086:Reoperation; D013118:Spinal Cord Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D016103:Spinal Fractures / Q000209:etiology*; D013123:Spinal Fusion / Q000009:adverse effects*; D013131:Spine / Q000378:metabolism*; D013904:Thoracic Vertebrae
D002131:Calcium Pyrophosphate