Functional Outcome in Dish Asssociated with Opll and Dens Hypertrophy Resulting in Rapidly Progressive Hemiplegia – A Case Report

Abstract

Study design: A case report of a patient with diffuse idiopathic skeletal hyperostosis (DISH) associated with ossification of posterior longitudinal ligament (OPLL) and dens hypertrophy resulting in spinal canal stenosis and progressive hemiplegia Objective: To demonstrate the excellent functional outcome following posterior spinal decompression and fusion.Methods: In December 2012, a 72-year-old male patient, who was diagnosed with hyperostosis of anterior and posterior longitudinal ligament 6 months ago, presented with rapidly increasing motor deficit of the left arm and unsecure gait pattern. X-rays, CT, and MRI diagnosed DISH and OPLL. Hyperintense signal in the C1 spinal cord on T2 weighted sequence was also observed. Patient underwent decompressive foraminotomy of foramen magnum and laminectomy of C1-C4 with Occiput -C5 fusion.Results: Neurological status and myelopathy improved to a great extent after surgical intervention. Conclusion:The current case demonstrates the scenario of DISH associated hemiplegia and the need for a posterior spinal decompression and fusion.

Simultaneous Diffuse Idiopathic Hyperostosis, Ossification of the Posterior Longitudinal Ligament and Ligamentum Flavum

“…Finally, neurologic deficit and abnormal gait reveal. Both DISH and OPLL prone the patient to compromise severely with minor trauma [20][21][22] and high mortality rate [23]. OLF also progresses gradually, and when the patient becomes symptomatic, compressive myelopathy, local pain and decreased mobility will develop [4].…”