Cervical Cord Compression Secondary to Ossification of the Posterior Longitudinal Ligament

Abstract

Study Design: Resident's case problem. Background: A 52-year-old Chinese male with a 10-year history of gradually worsening right hip stiffness, weakness, and pain was referred to physical therapy by his orthopedist, who made a diagnosis of developmental dysplasia of the right hip, with possible Legg-Calve-Perthes disease. The patient reported multiple falls over the last several years and a gradual onset of low back pain with an onset of ''electricity'' down both legs. The patient also reported mild numbness in both forearms and the right hand over the previous several months. This resident's case problem illustrates how a physical therapist recognized the presence of an atypical musculoskeletal pathology through the use of hypothesis-driven clinical reasoning and detailed physical examination. Diagnosis: Examination of the patient's lumbar and cervical spine and hips revealed joint dysfunctions. Neurological testing revealed hyperreflexia. Special testing revealed lower extremity clonus with a positive Babinski sign with gait disturbances. The patient was referred back to his primary physician and then to a neurologist and neurosurgeon. An MRI revealed cervical myelopathy due to ossification of the posterior longitudinal ligament from C3/C4 to C5/C6. The patient then underwent a C3 through C7 laminectomy. Discussion: It is always imperative that sound clinical reasoning be used when performing physical therapy evaluations, regardless of the referral status of the patient. Patients with nonmusculoskeletal pathology may seek physical therapy services and it is the physical therapist's responsibility to complete a thorough examination and refer to specialists when appropriate. J Orthop Sports Phys Ther 2005;35:722-729.

Cervical Ossification of the Posterior Longitudinal Ligament: A Computed Tomography–Based Epidemiological Study of 2917 Patients

“…Onset of OPLL is most common in men, in the fifth or sixth decade of life. 19,20 Symptoms are variable, although most significantly, OPLL can cause myelopathy, especially in the cervical spine. 21,22 The exact cause of symptoms is a combination of both static and dynamic factors, as the ossified ligament results in direct compression on the spinal cord in addition to restricting range of motion of the spine.…”

“…1,16 Distribution of age among patients with OPLL shows a significant difference from the sample, as is expected, with previous literature establishing diagnosis of OPLL at an average age of 50 years or greater. 19,20 This study does not determine onset of OPLL, or incidence, but rather prevalence. Interestingly, the OPLL cohort demonstrated a significant number of patients, 14 (19.0%), with OPLL of age 40 to 49 years.…”