Tumoral calcium pyrophosphate dihydrate deposition disease of the ligamentum flavum
Tumoral calcium pyrophosphate dihydrate deposition disease of the ligamentum flavum
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DOI：
10.1227/01.neu.0000068861.47199.a8
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发表时间：
2003-07-01
期刊：
影响因子：
4.8
通讯作者：
Karuppaswamy, U
中科院分区：
文献类型：
--
作者：
Muthukumar, N;Karuppaswamy, U
目的：焦磷酸钙二水合物（CPPD）沉积病（CPPDD），也被称为假性痛风，是很少知道影响脊柱。本文的目的是报告我们的经验与6例涉及大量局灶性沉积的黄韧带。方法：1998年1月至2002年6月，我们治疗了6例CPPDD涉及黄韧带的颈椎和胸椎。年龄45 ~ 70岁。有5名女性患者和1名男性患者。颈椎受累2例，胸椎受累4例。除一名患者外，其余患者均表现为隐性脊髓病发作，其余患者表现为外伤后截瘫。没有患者表现出任何CPPDD或其他可能导致CPPD沉积的代谢疾病的全身特征。普通X光片经常产生不确定的结果。计算机断层扫描和磁共振成像有助于确诊。所有患者均行椎板减压切除术，切除骨化的黄韧带。偏振光显微镜检查的切除黄韧带发现的特征棒形，双折射crystals.Results：五的6例患者经历了显着改善，他们的脊髓病变症状手术后。其余患者感觉改善，但运动能力无明显改善。在随访期间，范围从7个月到3年，没有一个病人提出了复发的CPPD晶体沉积在以前治疗的水平，但是，一个病人表现出改善手术后提出2年后，复发的脊髓病变的功能归因于骨化的黄韧带在一个新的level.CONCLUSION：肿瘤CPPDD的黄韧带是罕见的。多发于中老年女性，表现为进行性脊髓病，计算机断层扫描和磁共振成像是互补的诊断这种情况。手术，如果早期进行，导致良好的改善。然而，长期随访监测这些患者是因为手术提供了必要的，只能是症状的缓解而不能治疗。基础疾病。随着磁共振成像的日益普及，黄韧带骨化症越来越被人们所认识。在每一种情况下：黄韧带骨化，切除的标本应进行偏振光显微镜检查。我们认为，这种简单，廉价的方法将导致认识到更多的情况下，脊柱CPPDD。
OBJECTIVE: Calcium pyrophosphate dihydrate (CPPD) deposition disease (CPPDD), also known as pseudogout, is rarely known to affect the spine. The purpose of this ariticle is to report our experience with six cases involving massive focal deposition of the ligamentum flavum.METHODS: Between January 1998 and June 2002, we treated six patients with CPPDD involving the ligamententum flavum of the cervical and thoracic spine. Their ages ranged from 45 to 70 years. There were five female patients and one male patient. The cervical spine was involved in two cases and the thoracic spine in four. All except one patient Presented with an insidious onset of myelopathy, The remaining patient presented with paraplegia after trauma. None of the patients exhibited any systemic features of CPPDD or other metabolic conditions that can lead to CPPD deposition. Plain x-rays. often yielded, inconclusive results. Computed tomography and magnetic resonance imaging were useful in confirming the diagnosis. Decompressive laminectomy, with removal of the ossified ligamenta,flava, was performed for all patients. Polarized-light microscopic examinations of the excised ligamenta flava revealed the characteristic rod-shaped, birefringent crystals.RESULTS: Five of the six patients experienced significant improvements in their myelopathic symptoms after surgery. The remaining patient experienced improvements in sensations but no appreciable improvement in motor power. During the follow-up periods, which ranged from 7, months to 3 years, none of the patients presented with a recurrence of CPPD crystal deposition at the previously treated level However, one patient who exhibited improvement after surgery presented 2,years later with a recurrence of myelopathic features attributable to ossification of the ligamentum flavum at a new level.CONCLUSION: Tumoral CPPDD of the ligamentum flavum is rare. It commonly occurs among middle-age or elderly female patients and presents with progressive myelopathy., Computed tomography and magnetic resonance imaging are complementary in the diagnosis of this condition. Surgery, if performed early, leads to good improvement. However, long-term follow-up monitoring of these Datients is cause surgery provides necessary, be only symptomatic relief and does not treat the. underlying disease. With the increasing availability of magnetic resonance imaging, ossification of the ligamentum flavum is being more frequently recognized. In every case: of ossified ligamenturn flavum, the excised specimen should be examined with polarized-light microscopy. We think that this simple, inexpensive method will lead to the recognition of more cases of spinal CPPDD.