Case report

A rare case of extensive cervico-thoracic ossification of the posterior longitudinal ligament causing myelopathy

¹ Department of Orthopaedic Surgery, Spine Division, Tan Tock Seng Hospital, Singapore
² Department of Orthopaedic Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Tamil Nadu, India

^* Corresponding author. Department of Orthopaedic Surgery, Spine Division, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. E-mail address: Jacob_YL_OH@ttsh.com.sg (J. Y. L. Oh).

Received: 15 July 2018
Accepted: 25 July 2018

Abstract

Ossification of the posterior longitudinal ligament (OPLL) most commonly occurs in the cervical spine, usually involving two to three segments; however, the disease has the potential to occur anywhere in the spine. We encountered a fifty-one year old male with progressive unsteadiness and bilateral lower limb weakness for a period of six months which eventually became worse resulting in inability to walk without assistance. Neurological examination revealed normal upper limb function; however, the lower limbs demonstrated motor dysfunction. Signs of myelopathy were elicited and the patient was subjected to detailed radiological evaluation. CT and MRI scans revealed an extensive cervico-thoracic continuous OPLL from C3 to T3 causing significant cord compression. In view of the deteriorating neurological status, extensive C3-T3 laminectomy with instrumented posterolateral fusion was done and the patient recovered without any immediate or delayed C5 palsy. This case highlights a rare occurrence or extensive OPLL involving eight segments at the cervico-thoracic region. This report also discusses surgical strategies for managing such extensive presentations and our technique to prevent C5 palsy.