Journal of Radiology
Open Access

Ossification of the posterior longitudinal ligament (OPLL) is an important cause of cervical myelopathy that results from bony ossification of the cervical or thoracic posterior longitudinal ligament (PLL). It has been estimated that nearly 25% of patients with cervical myelopathy will have features of OPLL [1]. We report a case of 80-years-old man admitted in the neurological surgery department for cervico-brachial neuralgia with bilateral C6 root palsies. There were no other neurological findings associated. His past medical history was unremarkable. Cervical CT-Scan, sagittal view, shows a continuous type of OPLL extending over C2-C3-C4-C5-C6. The lesion is spontaneously hypodense with a broken sign, visible as a crack in ossification of the posterior longitudinal ligament plaque and also a hill-shape type (beak type) of OPLL at the C4-C5 level (Red arrow) Figure 1. The continuous type represents 25.97% of OPLL. The decision to treat these lesions is challenging. Various radiological parameters are used to evaluate cervical OPLL and to determine the surgical strategy Figure 2 [2]. For example, Fujiyoshi et al.[3] suggested that in the K-line (-) group, posterior decompression surgery would be unable to achieve a satisfactory posterior shift of the spinal cord and thus satisfactory neurologic improvement. Our patient is in this group. Moreover, looking at the patient advanced age, the decision for treatment or conservative management is very tricky. But the good news is that many other possibilities such as the anterior resection for OPLL with or without wide corpectomy and fusion or anterior and posterior combined surgery may be considered.

Figure 1: Cervical CT-Scan, sagittal view, shows a continuous type of OPLL spontaneously hypodense extending over C2-C3-C4-C5-C6 with hill-shape type (beak type) of OPLL at the C4-C5 level (red arrow).

Figure 2: Surgical approach indications.