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Our patient had an extremely rare type of pediatric Diffuse Midline Glioma (DMG) with modified H3 K27 that occurred in the cervical spinal cord. Due to its location in the spinal cord, slow clinical presentation with torticollis for 7 months, and the non-specific radiological appearance of this tumour, it was initially considered to be a low-grade glioma. Based on imaging findings, the neurosurgery team performed a complete surgical resection, but the pathological features were consistent with a high-grade, diffuse midline glioma. Therefore, we are reporting a case of an altered high-grade DMG H3K27 glioma, which is difficult to diagnose due to its slow clinical symptoms which caused a delay in diagnosis, non-specific imaging, and with difficulty in accessing histopathological markers in low and middle income countries (LMIC).

Ossification of the posterior longitudinal ligament (OPLL) is a condition of abnormal calcification of the posterior longitudinal ligament, mostly found in men, the elderly, and Asian patients, hence the name Japanese disease. The cervical spine area is the most typical location (75%), but can also affect the thoracic (15%) or lumbar (10%) spine. The spinal cord can be compressed by this lesion, which can cause neurological deficits. The treatment of choice for patients with symptomatic OPLL is surgery to relieve spinal cord compression. We report an exceptional case of lumbar ossification of the OPLL in a Moroccan patient.

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