CPPD crystal deposition disease of the cervical spine: A common cause of acute neck pain encountered in the neurology department
Introduction
The crystal-associated arthropathies form a group of metabolic diseases in which crystals, such as calcium pyrophosphate dihydrate (CPPD), basic calcium phosphate (e.g., hydroxyapatite and octacalcium phosphate), and monosodium urate, are deposited in and around joints, leading to inflammatory and destructive lesions. Pseudogout is one of the most common forms of crystal-associated arthritis associated with CPPD deposition in the joints and periarticular tissues [1], [2], [3]. The prevalence of CPPD deposition is extremely high and it is reported that knee chondrocalcinosis, which is assumed to be due to CPPD deposition, is found in 9.6% of individuals older than 50 years old, and this incidence increases with age [4], [5]. Attacks of pseudogout can be either monoarticular or oligoarticular, and the most commonly affected joints are the knees, followed by the shoulders, wrists, and ankles [2]. CPPD crystal deposition also induces arthritis mimicking rheumatoid arthritis (pseudorheumatoid arthritis) or osteoarthritis (pseudoosteoarthritis). However, CPPD crystal deposition on the cervical spine is less well known and only a limited number of cases of this condition have been reported to date [6], [7], [8], [9], [10], [11], [12], [13], [14].
Here, we report our recent clinical experience with 14 patients with CPPD crystal deposition disease of the cervical spine manifested by acute severe posterior neck pain. Acute neck pain is a common complaint among patients in the neurology department; however, it is sometimes difficult to make a precise diagnosis. Although a small number of patients have previously been reported, our recent clinical experience with 14 patients suggests that CPPD crystal deposition disease of the cervical spine is one of the most common underrecognized causes of acute neck pain.
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Patients and methods
Data from 14 patients with clinically and radiologically diagnosed CPPD crystal deposition disease of the cervical spine at our department during the period from January 2005 to December 2008 were analyzed retrospectively. The following data were collected from the medical records of the patients: gender; age; clinical course; inflammatory indicators, such as white blood-cell count (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level; radiological findings; and outcome.
Clinical findings
The data for the 14 patients are summarized in Table 1. The male-to-female ratio was 1.0 (7:7), and patients ranged in age from 54 to 92 with a mean ± SD of 77.5 ± 8.5. Thirteen patients (93%) were older than 70 years of age. None of the patients was previously diagnosed as having pseudogout or other crystal-associated arthropathies, although two patients had histories of severe neck pain attacks. The patients' chief symptoms were acute severe posterior neck pain (100%) and fever (79%). Nine (64%)
Discussion
Disease caused by CPPD crystal deposition was first described by McCarty et al. in 1962 [1]. CPPD deposition disease is a pathological process of crystal formation classically within articular, hyaline, and fibrocartilaginous structures, and can also be found in periarticular structures such as the joint capsule, tendons, and ligaments. This pathological process is especially common in the elderly [4], [5]; however, there have been relatively few reports regarding CPPD deposition on the
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