Cervical myelopathy due to ossification of the posterior longitudinal longitudinal ligament

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✓ Ten patients who had cervical myelopathy due to ossification of the posterior longitudinal ligament of the cervical spine are described. This disease is characterized by an abnormal longitudinal strip of ossified ligamentous tissue along the posterior margin of vertebrae from C-3 to C-6; the primary lesion appears to be a degeneration of the intervertebral disc. This distinct clinical, radiological, and pathological entity should be included in the differential diagnosis of cervical myelopathy. All 10 patients were treated by extensive decompressive laminectomy and multiple bilateral facetectomies, with or without foramen magnum decompression. The results were favorable, and postoperative myelography demonstrated dorsal migration of the entire dural contents.

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Address reprint requests to: Chikao Nagashima, M.D., 48 Ben-Ten-Cho, Shinjiku-ku, Tokyo 162, Japan.

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Figures

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    X-ray and soft x-ray visualization of the cervical spine with transverse sections. Soft x-ray specimens of C-5 and 6 may indicate laminar development of new bone. (From Furuya K, Yamaura I, Takayama M: Ossification of the posterior longitudinal ligament in cervical spine. A necropsy case. J. Jap. Orthop. Ass. 42:1131–1138, 1968, courtesy of the authors, Tokyo Medical and Dental University, Tokyo.)

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    Case 10. Left: Lateral laminogram. Disc protrusion can be identified by interruption of the longitudinal dense ossification at the level of C3–4 interspace. Center: Preoperative myelogram. There is complete myelographic block at C-4. Right: Postoperative myelogram after bilateral C3–4 and C4–5 facetectomy, decompressive C-1 to C-7 laminectomy, and foramen magnum decompression. Note good filling by contrast medium with dorsal migration of the dural tube.

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    Case 4. Left: Plain cervical spine film showing a strip of bone density along the floor of the spinal canal; its superior end at the C-3 vertebral body and its lower end is not clearly defined. Right: Laminogram showing bone density extending from C-3 to C-4, C-5 to C-6 (single arrow) and C-6 to T-1 (double arrow). Ossification of the anterior longitudinal ligament is also shown from C-5 to T-1, most marked at C6–7. There is mild spondylosis of the cervical spine with spurs and calcification on the anterior aspect of the C5–6 bodies, but no visible narrowing of the intervertebral spaces.

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    Case 1. Left: Preoperative lateral laminogram showing ossification along the posterior C-3 to C-5 vertebral margins. Center: Preoperative myelogram showing a partial block between C-6 and C-4. Right: Postoperative (1 month) myelogram showing dorsal migration of the dural tube away from the ossification between the posterior aspect of C-4 body and the Myodil column. Disc spaces are well preserved. There are no visible spondylotic changes nor calcification of the anterior longitudinal ligament.

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    Graph of the spinal canal diameters in patients with ossification of the posterior longitudinal ligament. Vertical lines mark the highest and lowest limits in patients with this disease. (Normal values are taken from Wolf B S, Khilnani M and Malis L: The sagittal diameter of the bony cervical spinal canal and its significance in cervical spondylosis. J. Mt. Sinai Hosp., 23:283–292, 1956, and cervical spondylosis values from Crandall P H and Batzdorf U: Cervical spondylotic myelopathy. J. Neurosurg., 25:57–66, 1966.)

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    Case 1. Postoperative frontal laminogram. The transverse diameter of the bone density at the level of the C-4 vertebra is 14 mm; it is not symmetrical and is deviated to the right.

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