If the knee hurts, don't forget the spine!

Calcium pyrophosphate dihydrate crystal-deposits (CPPD) at the spine are rare but the lesions detected with CT scans or MRI are often interpreted as a spondylodiscitis or osteitis. CPPD is a disease of the elderly without major sex predominance. The diagnosis of CPPD requires typical manifestations on a radiograph and/or detection of positively birefringent crystals in the synovial fluid of (peripheral) joints by compensated polarized light microscopy. CPPD crystal deposition at the spine has been associated with clinical manifestations, typically spine stiffness, and is sometimes associated with bony ankylosis or diffuse idiopathic skeletal hyperostosis. The preferred treatment of CPPD in the acute phase is oral non-steroidal anti-inflammatory medication or alternatively oral or intravenous glucocorticoids. CPPD should be considered in patients with non-specific spinal lesions.