[A case of myelopathy caused by calcified nodules of cervical ligamentum flavum].

A case is reported of a 71-year-old female with cervical myelopathy caused by calcified nodules in the cervical ligamentum flavum and improved by en bloc laminectomy. The calcified nodules were formed by the deposition of two crystals, hydroxyapatite (HAP) and calcium pyrophosphate dihydrate (CPPD). Light microscopy, scanning electron microscopy, energy dispersive X-ray microanalysis and X-ray diffraction study disclosed that the larger nodule located on the right was composed mainly of HAP in the central part and CPPD in the circumference. On the other hand, the smaller nodule located on the left was composed mainly of CPPD crystal. These findings support the hypothesis that calcification of the ligamentum flavum and CPPD crystal deposition disease in the cervical region are the same entity and the both are merely different aspects of the same entity at different chronological stages.

[A case of spontaneous cervical epidural hematoma associated with cervical spondylosis].

A case of spontaneous cervical epidural hematoma associated with long-term cervical spondylosis is presented. A 69-year-old man was admitted with a 3-day history of sudden onset of severe neck pain radiating to both upper extremities followed by impossibility in standing. Neurological examination on admission revealed paralysis below C7, total anesthesia below the T4 level and urinary incontinence. Initially, he was diagnosed as cervical cord injury caused by a violent fall. Subsequently, skeletal traction with tongs of the Crutchfield design was carried out. Nevertheless, he developed spinal shock 6 days after admission. A metrizamide myelogram followed by CT scanning 5 days after admission demonstrated an extradural isodensity mass displacing dura forward. The mass lesion was confirmed as spontaneous epidural hematoma by laminectomy from C4 to C7. Sudden onset of neck pain with radiation into both upper extremities should be differentiated cervical epidural hematoma from other cervical spinal lesions. Metrizamide CT is helpful to diagnose cervical epidural hematoma.