• Seiichi Odate, Jitsuhiko Shikata, Shunsuke Fujibayashi, Naoki Hosaka, Tsunemitsu Soeda, and Hiroaki Kimura.
• Department of Orthopaedic Surgery, Spine Center, Gakkentoshi Hospital, 7-4-1 Seikacho, Seikadai, Sorakugun, Kyoto, Japan. s-odate@iseikai.jp
• Eur Spine J. 2012 Dec 1;21(12):2436-42.

PurposeWe describe cases presenting with progressive thoracic myelopathy after lumbopelvic fusion attributed to proximal junctional vertebral compression fracture (PJF) followed by spinal calcium pyrophosphate dehydrate (CPPD) crystal deposition.MethodsThe study included six patients, ranging from 62 to 75 years. All patients had been treated previously with lumbopelvic fusion. The mean period from the detection of PJF to the onset of myelopathy was 4.8 months. Notably, five patients demonstrated upper-instrumented vertebra (UIV) collapse.ResultsAfter revision surgery involving decompressive laminectomy and extension of the spinal fusion, all patients experienced significant improvement. Photomicrographs of the resected ligamentum flavum showed CPPD crystals and multinucleated giant cells.ConclusionsThe combination of mechanical stress plus PJF and CPPD crystal deposition followed by a foreign body reaction to the deposited crystals caused myelopathy. Patients with radiographic evidence of PJF, especially UIV collapse, after lumbopelvic fusion should be followed carefully for the emergence of myelopathy.

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