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Case Reports
. 2017 May;26(Suppl 1):53-57.
doi: 10.1007/s00586-016-4731-x. Epub 2016 Aug 4.

Calcium hydroxyapatite crystal deposition with intraosseous penetration involving the posterior aspect of the cervical spine: a previously unreported cause of neck pain

Julio Urrutia  1 , Oscar Contreras  2
Affiliations
Case Reports

Calcium hydroxyapatite crystal deposition with intraosseous penetration involving the posterior aspect of the cervical spine: a previously unreported cause of neck pain

Julio Urrutia et al. Eur Spine J. 2017 May.

Abstract

Purpose: Calcific tendinitis is a frequent disorder caused by hydroxyapatite crystal deposition; however, bone erosions from calcific tendinitis are unusual. The spinal manifestation of this disease is calcific tendinitis of the longus colli muscle; this disease has never been described in the posterior aspect of the spine. We report a case of calcium hydroxyapatite crystal deposition involving the posterior cervical spine eroding the bone cortex.

Methods: A 57-year-old woman presented with a 5-month history of left-sided neck pain. Radiographs showed C4-C5 interspinous calcification with lytic compromise of the posterior arch of C4. Magnetic resonance imaging confirmed a lytic lesion of the posterior arch of C4, with a soft tissue mass extending to the C4-C5 interspinous space; calcifications were observed as very low signal intensity areas on T1 and T2 sequences, surrounded by gadolinium-enhanced soft tissues. A computed tomography (CT) scan confirmed the bone erosions and the soft tissue calcifications.

Results: A CT-guided needle biopsy was performed; it showed vascularized connective tissue with inflammatory histiocytic infiltration and multinucleated giant cells; Alizarin Red stain confirmed the presence of hydroxyapatite crystals. The patient was treated with anti-inflammatories for 2 weeks. She has been asymptomatic in a 6-month follow-up; a CT scan at the last follow-up revealed reparative remodeling of bone erosions.

Conclusion: This is the first report of calcium hydroxyapatite crystal deposition with intraosseous penetration involving the posterior aspect of the cervical spine. Considering that this unusual lesion can be misinterpreted as a tumor or infection, high suspicion is required to avoid unnecessary surgical procedures.

Keywords: Calcific tendinitis; Cervical spine; Crystal deposition disease; Hydroxyapatite; Neck pain.

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References

    1. AJR Am J Roentgenol. 2003 Oct;181(4):965-72 - PubMed
    1. AJR Am J Roentgenol. 1987 Nov;149(5):967-70 - PubMed
    1. Skeletal Radiol. 2015 Oct;44(10):1403-12 - PubMed
    1. Skeletal Radiol. 2000 Dec;29(12 ):690-6 - PubMed
    1. Semin Arthritis Rheum. 2014 Jun;43(6):824-9 - PubMed

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