Cervical myelopathy caused by calcium pyrophosphate dihydrate crystal deposition in facet joints. A case report.

Abstract

This report illustrates a case of cervical myelopathy caused by degenerative changes of the facet joints in which calcium pyrophosphate dihydrate crystals were found histologically. To evaluate the treatment of this patient, which involved the principles of laminoplasty and posterolateral fusion, and to analyze surgical specimens and preoperative radiographs taken after the patient's surgery. Calcium pyrophosphate dihydrate deposition occurs in cartilage, ligaments, tendons, and joint capsules. Radiographic changes of the cervical facet joints caused by such deposition have already been reported in cadaveric studies. Cases with neurologic compromise rarely occur. Surgical specimens that were obtained from the cervical facet joints, i.e., capsule and synovium, were analyzed histopathologically. The preoperative radiographic study showed severe degenerative changes of the cervical facet joints, and analysis of the surgical specimens indicated the presence of calcium pyrophosphate dihydrate crystals. The cervical facet joints can be involved in calcium pyrophosphate dihydrate crystal deposition and this involvement may accelerate the degenerative changes of the facet joints.