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Case 17

History:

54 year old male with chronic neck pain and bilateral upper extremities numbness

Findings:

Lateral view of the cervical spine showing linear ossification posterior to the C4 and C5 vertebral bodies.

Diagnosis:

Show Diagnosis

Discussion:

When hypertrophied or ossified the posterior longitudinal ligament.(PLL) may cause myelopahty and/or radiculopathy by compression mechanism. Age 32-81 with mean pf 53. Slight male predominance. Prevalent in Japan. Pathophysiology unknown.  OPLL begin with hypervascular fibrosis followed by focal areas of calcification, proliferation of periosteal cartilaginous cells and finally ossification. The process frequently extends to the dura. Eventually active bone marrow production may occur. Cervical distribution 70-75%, thoracic 15-20%, lumbar 10-15%. Can be segmental confined to the space behind the vertebral body without crossing the disc space or continuous extending from VB to VB spanning the disc space.

References:

  • Onji Y, Akiyama H, Shimomura Y, Ono K, Hukuda S, Mizuno S. Posterior paravertebral ossification causing cervical myelopathy. A report of eighteen cases. J Bone Joint Surg Am. 1967 Oct;49(7):1314–1328.
  • Hiramatsu Y, Nobechi T. Calcification of the posterior longitudinal ligament of the spine among Japanese. Radiology. 1971 Aug;100(2):307–312.
  • Nagashima C. Cervical myelopathy due to ossification of the posterior longitudinal ligament. J Neurosurg. 1972 Dec;37(6):653–660.
  • Nakanishi T, Mannen T, Toyokura Y, Sakaguchi R, Tsuyama N. Symptomatic ossification of the posterior longitudinal ligament of the cervical spine. Clinical findings. Neurology. 1974 Dec;24(12):1139–1143.
  • Hanai K, Adachi H, Ogasawara H. Axial transverse tomography of the cervical spine narrowed by ossification of the posterior longitudinal ligament. J Bone Joint Surg Br. 1977 Nov;59-B(4):481–484.