Posterior Longitudinal Ligament Calcification with Myelopathy - A Case Report

Ossification of the posterior longitudinal ligament (OPLL) constitutes a significant etiology of cervical myelopathy. The most common clinical presentations are myelopathy and radiculopathy, which result from a decrease in the spinal canal's volume and the spinal cord's subsequent compression by the ossified posterior longitudinal ligament. This results in motor and sensory deficits, especially in the extremities. A 48-year-old male presented with a complaint of neck pain that radiated to both upper limbs and was associated with numbness, tingling, and paranesthesia. He also had a history of lower back pain that radiated to the right leg, which was also associated with numbness and limited mobility to his cervical spine. Lhermitte's sign was positive. Sensory deficit to pinprick and touch was noted in the right upper limb and lower limbs. Flexion deformities of the right hand and elbow extension fingers were noted. Neuroimaging of the cervical spine showed cervical canal stenosis, OPLL, and myelopathy. Surgical management included internal fixation using plates and transpedicular screws, lateral mass fixation, and laminectomy of the third to sixth cervical vertebrae (C3-C6). OPLL should be considered an integral component of the differential diagnosis when evaluating a patient with neck pain and consequent motor and sensory deficits of the extremities. OPLL with mild and/or non-progressive symptoms can be addressed with non-operative measures. Assessing preoperative neuroimaging is crucial before surgery to determine the degree of spinal cord compression and the presence of OPLL in all patients with cervical myelopathy. Surgical treatment options for posterior longitudinal ligament calcification include laminectomy and fusion, anterior decompression including transpedicular and costo-transversectomy, laminoplasty, and circumferential decompression via staged posterior and anterior approaches. Determining the most effective surgical approach for managing OPLL is still controversial, and selecting the appropriate procedure should be based on the patient's clinical presentation and level of pathological involvement.