Background Few systematic studies of spinal CPPD have been published
Objectives To further characterise spinal involvement of CPPD by a systematic study of CPPD patients hospitalized in a rheumatology department.
Methods We retrospectively reviewed all the files of patients consecutively admitted for CPPD in the rheumatology department of the Lariboisière hospital in Paris, France from May 2006 to May 2011, using a standardized protocol. Imaging studies (that had been indicated for symptomatic involvement) were reviewed.
Results During the 5 year-period, a diagnosis of CPPD was made because of peripheral chondrocalcinosis (n=87) and/or synovial fluid demonstration of CPP crystals (n=65) in 101 women and 51 men (mean age 78 yrs). Spinal CPPD was diagnosed in 37 (24.3%) patients who did not differ from the whole series by age, sex, CPPD etiology, peripheral joint involvement distribution and pattern.
The cervical spine was affected in 21 patients. Peri-odontoid calcifications were identified at CT-scan in 19/21 patients (8/21 by conventional radiography (CR), who suffered from acute (n=12) or chronic (n=4) neck pain radiating to the occiput in 6. Dens erosion was observed at CT-scan in 13 patients, and associated with a dens cyst in 5 and C1-C2 dislocation in 6. CT-scan and MRI disclosed destructive C1-C2 arthropathy, massive calcification and panus-like hypertrophy behind the dens in 3 patients with neurological impigement. A grade 2 dens fracture was evidenced in another one. Multiple C2-T1 intervertebral disc calcifications (IVDC) in the peripheral nucleus and/or vertebral cartilagenous endplates were observed at CT-scan and CR in 13/18 and 8/21 patients respectively. OA features were common. 7 patients had vacuum phenomenon of at least one disc. Spondylolisthesis of the uper (C2-C4 segment) and lower cervical spine was seen in 3 and 7 patients respectively, associated with mechanical cervical or cervicobrachial pain.
Thoracic IVDCs were found at CT-scan in 4 symptomatic patients.
Among 19 patients with lumbar involvement, IVDCs were seen at CT-scan in 17 patients (multiple in 15), with annular, nuclear and global pattern in 9, 1 and 7 patients respectively. A vacuum phenomenon was seen in 7. CT-scan showed calcifications in the ligamenta flava, interspinal ligament and interapophyseal hyaline cartilage in 6, 3 and 1 patients respectively. A degenerative spondyloslisthesis was seen at standing CR in 8 patients, with dislocation of the upper lumbar spine in 2. Symptomatic lumbar canal stenosis was documented in 12 patients.
Disc inflammation was observed at MRI. One patient had 3 Mobic type1 lesions with no erosion; 6 had clinical and imaging features compatible with disc infection (2 cervical, 2 thoracic, 4 lumbar). Percutaneous disc biopy was sterile in 5 patients and disclosed tuberculosis infection in one.
Sacro-iliac calcifications were seen in 5 patients, associated with a destructive sterile sacroiliitis and fusion in one patient each.
Conclusions Symptomatic involvement of the spine was observed in 24% of this series of hospitalized CPPD patients. CT-scan was more sensitive than CR for the diagnosis of calcification. 6 patients underwent percutaneous disc biopsy leading to the diagnosis of tiuberculosis in one
Disclosure of Interest None declared