The association of ossification of the posterior longitudinal ligament (OPLL) and diffuse idiopathic skeletal hyperostosis (DISH) has been recently described. It may result in devastating compressive myelopathy. We report a case of quadriplegia complicating OPLL in a patient with DISH. In addition, we present a brief review of the literature on OPLL. This report illustrates the importance of appropriate neurologic and radiologic evaluation of persons with DISH, to help prevent severe neurologic complications.Diffuse idiopathic skeletal hyperostosis (DISH), originally considered to be an incidental radiographic finding with limited clinical significance (l), is a common disorder that is characterized by calcification and bony outgrowth at sites of ligamentous and tendinous insertions to bone (1,2). Typically, the hyperostotic changes involve the anterolateral aspect of vertebral bodies, but as Resnick and coworkers (2) have emphasized, this ossifying diathesis occurs at extraspinal locations and may do so in the absence of spinal involvement.Ossification of the posterior longitudinal ligament of the spine (OPLL) is a recently recognized Submitted for publication September 10, 1986; accepted in revised form December 18, 1986. entity. It is frequently asymptomatic (3,4) but may, on occasion, induce a severe myelopathy (4-15). OPLL has been found mainly in Japan (3-9), where after 1960, the number of reported cases increased rapidly. In 1974 the Ministry of Public Health and Welfare of Japan instituted a special study group to evaluate the frequency, etiology, and salient clinical and radiologic features of OPLL, as well as to delineate its proper management. Since 1975, more than 2,100 Japanese patients with symptomatic OPLL have been investigated (4). In contrast, only a limited number of cases of OPLL have been reported among non-Japanese individuals (1Cb14).It is now recognized that OPLL and DISH may coexist and may result in devastating neurologic sequelae (4,10,12,13,15). We describe a patient with DISH, in whom OPLL was complicated by quadriplegia. We propose an evaluation that should be conducted in all patients with DISH, to prevent the occurrence of severe neurologic complications.Case report. The patient, a 63-year-old, previously healthy black man, was found to be hypotensive and confused shortly after he fell down a flight of stairs. He had reported a sudden onset of cervical pain after the fall. The neurologic examination revealed an incomplete quadriplegia with a bilateral T1 level for all sensory modalities, as well as an areflexic motor deficit below C6. Cranial nerves were intact, and examination of the head revealed no external injury. The patient was treated conservatively and immobilized in traction with skull tongs.Radiographs of the cervical spine revealed no evidence of fracture or dislocation, but demonstrated bony proliferation anterior to the vertebral bodies that was compatible with DISH ( Figure 1). Anteroposterior
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