J Korean Med Sci.  2012 Dec;27(12):1591-1594. 10.3346/jkms.2012.27.12.1591.

Cauda Equina Syndrome Caused by Pseudogout Involving the Lumbar Intervertebral Disc

• Lee J
• Cho KT
• Kim EJ

• KMID: 2157988
• DOI: http://doi.org/10.3346/jkms.2012.27.12.1591

Abstract

Calcium pyrophosphate dihydrate (CPPD) deposition disease, also known as pseudogout, is a disease that causes inflammatory arthropathy in peripheral joints, however, symptomatic involvement of the intervertebral disc is uncommon. Herein, we describe a 59-yr-old patient who presented with cauda equina syndrome. Magnetic resonance imaging of the patient showed an epidural mass-like lesion at the disc space of L4-L5, which was compressing the thecal sac. Biopsy of the intervertebral disc and epidural mass-like lesion was determined to be CPPD deposits. We reviewed previously reported cases of pseudogout involving the lumbar intervertebral disc and discuss the pathogenesis and treatment of the disease.

Keyword

Calcium Pyrophosphate Dehydrate (CPPD); Pseudogout; Lumbar Spine; Intervertebral Disc

MeSH Terms

Calcium Pyrophosphate/metabolism
Chondrocalcinosis/etiology
Diskectomy
Humans
Intervertebral Disc/pathology/surgery
Magnetic Resonance Imaging
Male
Middle Aged
Polyradiculopathy/*diagnosis/pathology/radiography
Tomography, X-Ray Computed
Calcium Pyrophosphate

Figure

• 

  Fig. 1 Magnetic resonance imaging and computed tomography of the lumbar spine. (A) A T2-weighted sagittal image shows an epidural mass with heterogeneous signal intensity and the thecal sac is severely compressed by the mass. Focal low density (black arrows) in the lesion is suggestive of calcification. (B) Non-contrast and (C) contrast T1-sagittal image show enhancement (white arrows) in adjacent to the posterior longitudinal ligament. (D) Non-contrast T2- and (E) T1-weighted axial image show the thecal sac is severely compressed by the mass. (F) Computed tomography shows sparse calcification.

• 

  Fig. 2 Histopathologic study of the intervertebral disc and epidural mass-like lesion. Irregular crystalline deposits of calcium pyrophosphate dihydrate are present in the intervertebral disc and epidural mass-like lesion (H&E stain, × 40).

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