Progressive thoracic myelopathy caused by spinal calcium pyrophosphate crystal deposition because of proximal junctional vertebral compression fracture after lumbopelvic fusion
Progressive thoracic myelopathy caused by spinal calcium pyrophosphate crystal deposition because of proximal junctional vertebral compression fracture after lumbopelvic fusion
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DOI：
10.1007/s00586-012-2410-0
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发表时间：
2012-12-01
影响因子：
2.8
通讯作者：
Kimura, Hiroaki
中科院分区：
文献类型：
--
作者：
Odate, Seiichi;Shikata, Jitsuhiko;Kimura, Hiroaki
我们描述了因近端交界处椎体压缩骨折（PJF）导致的腰椎骨盆融合后出现进行性胸椎脊髓病，随后出现脊柱焦磷酸钙结晶沉积（CPPD）的病例。所有患者既往均接受过腰骨盆融合术治疗。从检测到PJF到脊髓病发作的平均时间为4.8个月。值得注意的是，5例患者表现为上器械椎体（UIV）塌陷，经过包括椎板减压和脊柱融合延长的翻修手术，所有患者均获得了显著改善。切除的黄韧带的显微照片显示CPPD晶体和多核巨细胞。机械应力加上PJF和CPPD晶体沉积的组合，然后对沉积的晶体产生异物反应，导致脊髓病。腰椎骨盆融合术后有影像学PJF证据的患者，尤其是UIV塌陷，应仔细随访是否出现脊髓病。
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.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.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.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.