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Biomedicine (Taipei). 2018 Dec;8(4):27. doi: 10.1051/bmdcn/2018080427. Epub 2018 Nov 26.

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

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


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.

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