Ossification of the posterior longitudinal ligament with severe canal stenosis
Presentation
50 year old Chinese man presents with bilateral upper limb sensory loss following a sports-related fall.
Patient Data
There is multilevel short segment calcification of the posterior longitudinal ligament between C3 and C6 causing severe narrowing of the central canal. Central canal stenosis is most severe at C5/6, where it compresses more than 50% of the AP canal diameter. There is no acute fracture.
MRI confirms the CT findings. It also demonstrates intramedullary T2 high signal extending from C2/3 to C5/6 with no evidence of cord hemorrhage. Again, there is no other evidence of bony or ligamentous injury.
Case Discussion
Ossification of posterior longitudinal ligament (OPLL) is demonstrated in a patient with typical demographics for this condition. The intramedullary signal abnormality most likely represents acute cord edema in the setting of relatively minor trauma, and the severe canal stenosis. Differential is longstanding myelomalacia.
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