Tetraparesis secondary to cervical ossification of the posterior longitudinal ligament: case report

Abstract

Ossification of the posterior longitudinal ligament (OPLL) has been a relatively common cause for myelopathy in Korea and Japan since its first description by Tsukimoto in 1960 1,2 . OPLL occurs in perhaps only 0.2% of the Caucasian population 3 , whereas its prevalence in Japan has been reported as of 1.5-2.4% in adults 4 . The rarity of the condition in non-Oriental populations often leads to delay and/or failure of recognition. We report an OPLL in a 54-year-old Afro-Brazilian woman who had tetraparesis and a diagnosis based on clinical and radiological investigation. The aim of this report is to discuss the relevant aspects of OPLL, mainly its clinical presentation and diagnosis. CASEA 54-year-old hypertensive woman was hospitalized (HU-UFJF-SAME 347836) with approximately four months of gait impairment. On orthopedical evaluation, spastic tetraparesis and trunk instability were observed. In addition to this, on neurologic consultation, increased deep tendon reflexes of both upper and lower extremities were detected. There were no abnormalities on upper-and-lower-limb cerebelar and sensitive examinations. Nor family background or spondylosis, diabetes, trauma, irradiation history were positive.Radiographs revealed a hyperdense image at the cervical vertebral canal (Fig 1). A computed tomogram (CT) showed a mass of ossification compressing fifty percent of the spinal cord in the posterior aspect, from the 3 rd to the Tetraparesia secundária a ossificação do ligamento longitudinal posterior cervical: relato de caso RESUMO -Ossificação do ligamento longitudinal posterior (OLLP) é causa rara de mielopatia na população não Oriental e relativamente subdiagnosticada por clínicos gerais. Relata-se um caso de mulher de 54 anos descendência Afro-Brasileira com tetraparesia associada a OLLP cervical. Enfatiza-se a inclusão da OLLP como diagnóstico diferencial de mielopatia cervical compressiva.PALAVRAS-CHAVE: ossificação do ligamento longitudinal posterior, compressão da medula espinhal, estenose espinhal.

Spinal cord infarction at the level of ossification of the posterior longitudinal ligament

“…[8][9][10][11] Our search of the literature, with 'OPLL' and 'tetraplegia' or 'quadriplegia' as keywords in PubMed and Embase (April 2016), found two reports in the literature of tetraplegia in the absence of obvious trauma in patients with OPLL. 12,13 However, these 2 cases had previous neurological symptoms several months before admission.…”