Compressive cervical myelopathy due to calcium pyrophosphate dihydrate deposition in ligamentum flavum: A case report and review of literature

INTRODUCTION: Symptomatic calcification of ligamentum flavum (CLF) is a rare condition of the cervical spine compared to other degenerative diseases. CLF manifests as myelopathic symptoms due to the compression of the spinal cord. Calcium pyrophosphate dihydrate (CPPD) deposition disease is the most prevalent cause of CLF. This is the first reported case of CLF caused by CPPD in the Middle East. PRESENTATION OF CASE: A 75-year-old female patient presented with gait disturbance for two years. The imaging studies demonstrated two symmetric bulging masses with a density similar to bone between the inferior border of the C5 laminae and the superior border of the C6 laminae. Histologic evaluation of the resected tissue confirmed the CLF and CPPD disease pathology. The patient underwent a C5-C6 laminectomy. The symptoms resolved, and in a six-month follow-up period, the walking improved. DISCUSSION: The diagnosis of CLF due to CPPD is based on the interpretation of the symptoms concurrent with MRI, CT scan, and histopathological examination. Due to the high reoccurrence rates of the condition following the pharmacological treatment and sub-optimal response in those with negative inflammatory markers, open decompression with either cervical laminectomy or laminoplasty is considered the gold-standard therapeutic option in CFL due to CPPD deposition disease. CONCLUSION: CLF is a rare cervical spine disorder that compresses the spinal cord and manifests as myelopathic symptoms. Early surgical intervention, preferably in the first five months of the disease initiation, is associated with favorable outcomes.