Acute exacerbation of cervical myelopathy caused by pseudogout of the cervical ligamentum flavum after cervical spinal cord injury: a case report

Abstract

Introduction: Calcification of the ligamentum flavum can cause acute neck pain and compression of the spinal cord, which can induce myelopathy. However, there are very few reports of acute exacerbation of myelopathy due to a pseudogout attack of the cervical ligamentum flavum, and there are no reports of that after a cervical spinal cord injury. Here, we report the case of a patient with acute neck pain and tetraplegia caused by pseudogout attack of the cervical ligamentum flavum after cervical central spinal cord injury. Case presentation: A 78-year-old man experienced mild tetraplegia after falling. He was diagnosed with cervical spinal cord injury without radiographic abnormality. Four days after the injury, he developed fever and his paralysis worsened. Magnetic resonance imaging revealed increasing of spinal stenosis at the C4–5 level. Computed tomography revealed calcification of the ligamentum flavum at the same level. C3 laminectomy and C4-5 laminoplasty were performed. A collection of turbid yellow fluid was found in the ligamentum flavum. A histopathological examination revealed evidence of calcium pyrophosphate dihydrate crystals in the fluid. Discussion: With increase in the aging population in Japan, the patients with acute exacerbation of myelopathy due to pseudogout in the cervical spine following spinal cord injury without radiographic abnormality may increase in the future. Computed tomography is useful for the diagnosis of such cases.