Calcium pyrophosphate dihydrate crystal deposition disease: a case of cervical myelopathy in an elderly woman.

Cervical cord compression in elderly patients is usually degenerative in origin. We report a case of cervical cord compression due to focal deposition of calcium pyrophosphate dihydrate (CPPD) crystals in the ligamentum flavum. A 76 year old woman presented with a 3 week history of severe neck pain associated with intermittent L’Hermitt’s type electric shock sensations down both arms. Over this period she noticed clumsiness of her hands and became unsteady on her feet. For several years she had complained of mild neck pain and stiVness. She walked with a broad based ataxic gait and had brisk reflexes and hypertonia in both lower limbs with reduced muscle power MRC grade 4/5 below the C7 level bilaterally. In the upper limbs, the triceps reflexes were brisk. An MR scan of the cervical spine showed a focal, non-enhancing, posteriorly based soft tissue mass at theC 4/5 level extending laterally within the spinal canal in a symmetric fashion and causing cord compression (figure, A, B). The patient underwent laminectomy at C4 and C5 with excision of a thickened band of ligamentous tissue which was of gritty consistancy and yellow grey in colour. The dura was intact and cord pulsation was noted after decompression. Postoperative recovery was uneventful and the patient was discharged 9 days after surgery. Histological examination of the excised ligamentum flavum showed fibrocartilaginous