Quadriparesis Complicating Atlantoaxial Subluxation and Ossification of the Posterior Longitudinal Ligament in a Patient with Rheumatoid Arthritis: A Case Report

Shirado, Osamu; Azuma, Hirotaka; Takeda, Naokazu; Minami, Akio

doi:10.2106/jbjs.d.02083

Cited by 1 publication

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“…However, some authors disagreed with this hypothesis and proposed the pathology of combined upper cervical cord compression and cervical OPLL is that upper cervical cord compression occasionally occurred in patients with cervical OPLL. For example, Shirado et al [ 20 ] reported a case of cervical myelopathy due to combined atlantoaxial subluxation and cervical OPLL. They thought it is just a rare coincidence that cervical OPLL occasionally occurred in a rheumatoid arthritis patient with atlantoaxial subluxation, which resulted in cervical myelopathy.…”

Section: Discussionmentioning

confidence: 99%

Radiological manifestations and surgical outcome of combined upper cervical cord compression and cervical ossification of the posterior longitudinal ligament with a minimum 2-year follow-up

Zhou

Chen

et al. 2017

Medicine

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Combined upper cervical cord compression associated with cervical ossification of the posterior longitudinal ligament (OPLL) is a rare and under-recognized disorder. The aim of this study was to investigate the radiological manifestations and surgical outcome of this combined disease.Between May 2011 and July 2015, patients who underwent surgery for combined upper cervical cord compression and cervical OPLL in our institution were included in this study. After a minimum 2-year follow-up, radiological and clinical data were collected. The etiology of upper cervical cord compression and radiological features of cervical OPLL was determined. Surgical outcome was evaluated with Visual Analogue Scale (VAS), Japanese Orthopedic Association score (JOA), space available for the spinal cord (SAC) at the cephalad adjacent level, occupying ratio of OPLL and cervical lordosis.In total, 24 patients (11 men and 13 women) with a mean age of 57.9 years old were included. The etiology of upper cervical cord compression included craniovertebral junction deformity (n = 10), atlantoaxial subluxation (n = 5), and OPLL extending to C2 level (n = 9). The extent, type, and thickest level of cervical OPLL varied among the patients. Significant improvement of VAS and JOA score was noted postoperatively and at a minimum 2-year follow-up. The result was satisfactory in SAC at the cephalad level and occupying ratio of OPLL. There were no significant differences in C2/C7 lordotic angle at the preoperative, postoperative and the last follow-up examination.In conclusion, the radiological manifestations of combined upper cervical cord compression and cervical OPLL varied among the patients. Satisfied results can be achieved with adequate surgical treatment a minimum 2-year follow-up.

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Section: Discussionmentioning

confidence: 99%