Ossification of Transverse Ligament of Atlas Causing Cervical Myelopathy: A Case Report and Review of the Literature

Abstract

A case of ossification of transverse ligament of atlas (TLA) is reported. A 76-year-old female suffered from a transverse type myelopathy was successfully treated by posterior decompression. Dynamic lateral plain radiographs showed irreducible atlantoaxial subluxation (AAS). A computed tomogram revealed ossified mass compatible to ossification of TLA. Coalition of the atlantooccipital joints and osteoarthritis of the atlantoaxial joints with degenerated dens was also revealed. Magnetic resonance imaging showed compressed spinal cord at C1 level by the ossification of TLA and AAS. We suggest a mechanism of ossification of TLA as follows: hypertrophied dens and stress to the atlantoaxial joints caused by coalition of atlantooccipital joints could make forward shift of atlas leading to irreducible AAS, and continuous tension given to TLA from irreducible AAS would result in hypertrophied and ossification of TLA.

Ossification of the cruciform ligament of atlas; a rare cause of cervical myelopathy: Case report and review of literature

“…Consequently, for compression to occur at, this level would require a significantly large lesion or a compromise of the bony canal (congenital anomalies, trauma, intervention). [6,7] [2]…”

“…Ossification of the cruciform ligament (also known as cruciate ligament) of atlas is a rare phenomenon. [1][2][3][4] To the best of our knowledge, there have been only 16 cases reported in literature thus far. In this article, we present a case of cervical myelopathy secondary to ossification of the cruciform ligament of atlas.…”

Upper Cervical Compression Myelopathy Caused by the Retro-Odontoid Pseudotumor With Degenerative Osteoarthritis and Calcium Pyrophosphate Dihydrate Disease: A Case Report and Literature Review

“…34 Cervical compression myelopathy also resulted from degenerative AAS 14 and/or dens hypertrophy. 11,35,36 The periodontoid soft-tissue mass resembling to the pseudotumor was detected in 90% of 108 surgically treated patients with degenerative atlantoaxial instability resulting from trauma and congenital anomaly without RA or CPPD. 37 The pseudotumor with amyloid deposition can be caused by atlantoaxial instability due to secondary OA in hemo-dialysis patients.…”

“…[3][4][5] The pseudotumor can occur even in patients without RA, 6 which is however a rare condition in upper cervical osteoarthritis (OA). 1,7 Although the development of OA is multifactorial, altered mechanical properties arising from degenerative instability 8,9 with calcification and/or ossification 10,11 are the primary cause. 12 Then, OA can secondarily be developed often more severely by other factors includ-ing trauma, inflammation, e.g., gout, and metabolic disorders, e.g., diabetes.…”

Unusual Atlantoaxial Stenosis Adjacent to Long Segment Cervical Spinal Fusion

“…transverse ligament of the atlas (a strong band that crosses the ring of the atlas and maintains the odontoid process by being in contact with the atlas) or atlantoaxial ligament can become ossified. [5][6][7][8][9] In this patient, MRI findings were suggestive of anterior and posterior stenosis of the spinal canal that could be attributed to ossification on both sides. However, CT scans showed only anterior OTLA and a hypoplastic posterior arch with mere flecks of bone, thus ruling out the possibility of posterior bony hypertrophy or ligamentous ossification.…”