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Review
. 2022 Oct 6:15:7639-7656.
doi: 10.2147/IJGM.S360714. eCollection 2022.

Lumbar Spinal Involvement in Calcium Pyrophosphate Dihydrate Disease: A Systematic Literature Review

Aicha Ben Tekaya  1   2 , Lilia Nacef  1   2 , Mehdi Bellil  2   3 , Olfa Saidane  1   2 , Leila Rouached  1   2 , Selma Bouden  1   2 , Rawdha Tekaya  1   2 , Ines Mahmoud  1   2 , Leila Abdelmoula  1   2
Affiliations
Review

Lumbar Spinal Involvement in Calcium Pyrophosphate Dihydrate Disease: A Systematic Literature Review

Aicha Ben Tekaya et al. Int J Gen Med. .

Abstract

Background: Calcium-pyrophosphate-dihydrate-disease (CPPD) is a crystal-induced arthropathy. The lumbar-spinal involvement is rare and often under-diagnosed. This study aimed to report the case of a lumbar spine CPPD involvement and to perform a systematic review of clinical, imaging features of lumbar involvement in CPPD patients, and treatments that have been implemented.

Methods: This systematic review was conducted in accordance with the Preferred-Reporting-Items-for-Systematic-Reviews and Meta-Analyses (PRISMA) guidelines.

Results: One hundred and sixty-seven articles met the search criteria using electronic databases searches. We retained 28 articles (20 case reports, 2 case series, 1 family survey, 4 retrospective studies, and 1 prospective study) involving a total of 62 patients. The age ranged between 39 and 89 years old. Among patients with lumbar spine CPPD, 32 were women. The duration of symptoms varied between one day and 8 years. The affection has been discovered during back pain in most cases. In 5 studies, the diagnosis was made on histological specimens of patients operated on for another pathology. X-ray showed calcifications in 2 cases. CT-scan detected calcium deposit in 7 cases. MRI showed lesions going from the increased signal of the disk, to calcified or not-cystic lesion of the facet joints, an intramedullary mass mimicking a schwannoma. Histological examination established the diagnosis of CPPD in 21 patients in all studies. Medical treatment included NSAIDs, Colchicine, Interleukin-1-receptor-antagonist, and antibiotics. Surgery was performed on 13 patients and allowed to establish the histological diagnosis.

Conclusion: In the case of inflammatory back pain in elderly subjects, without an infectious gateway, diagnosis of CPPD should be considered, especially for patients with a history of spinal surgery or degenerative radiography changes. CT scan is more sensitive than conventional radiographs. The discovertebral biopsy is the Gold-Standard and should be performed whenever the diagnosis was uncertain. Treatment includes the medical and surgical components.

Keywords: calcium pyrophosphate dihydrate disease; chondrocalcinosis; radiculopathy; sciatica; spine.

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Conflict of interest statement

The authors report no conflict of interest in this work.

Figures

Figure 1
Figure 1
A CT-scan sagittal image shows linear calcification into the L3-L4, L4-L5 and L5-S1 (Arrow) intervertebral discs.
Figure 2
Figure 2
Axial CT-scan image of the lumbar spine, exhibiting calcification of the interapophyseal joint cartilage (Red Arrow) in (A) and ligamentum flavum (Black Arrow) in (B).
Figure 3
Figure 3
AxialCT-scan image of the pelvis showing linear bilateral calcification of the sacroiliac joint (Head arrow).
Figure 4
Figure 4
Flow chart of the study.
See this image and copyright information in PMC

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