Cervical canal stenosis due to ossification of the posterior longitudinal ligament

Case contributed by Bruno Di Muzio



Patient Data

Age: 54-year-old
Gender: Male
Chronic non-of the right posterior arch of C1 is noted. Whether this is congenital or represents an old injury is uncertain. No facet joint dislocation. There is no acute bony injury noted. There is a posterior disc osteophyte complex at the C5-6 level which measures almost 6 mm and causes spinal canal stenosis with cord compression. The soft tissues of the neck are normal. Lung apices are unremarkable.

The vertebral bodies have normal height and alignment. Nonunion of the C1 posterior arch on the right (more conspicuous on CT) is consistent with an anatomical variant. There is degenerative ankylosis of C4 and C5 vertebral bodies associated with MODIC 2 signal changes of their interposed endplates. No bone marrow edema, facet joint effusion or abnormal disc signal. Anterior to the C4-C6 vertebral body there is a thin layer of prevertebral high signal however this is not associated with evidence of anterior longitudinal ligament or disc disruption. The posterior longitudinal ligament and ligamentum flavum appear intact. No posterior soft tissue bruising or hematoma. No epidural abscess. Bulky osteophytes/ossification of the posterior longitudinal ligament from C4 to C6/7 is eccentric to the right. This causes severe canal stenosis and cord compression posterior to C5 and C5/6; associated cord edema extends between C4/5 and C6/7. Disc osteophyte complex at C4/5 impinges upon the passing right ventral nerve root and causes moderate right and mild left foraminal stenosis.

At C5-6 the eccentricOPLL/osteophytosis impinges the pre-foraminal right C6 nerve root, and left uncovertebral osteophytes cause moderate left foraminal narrowing. At C6-7, there is mild indentation of the thecal sac by right paracentral protrusion without cord contact or foraminal stenosis.

Case Discussion

Ossification of the posterior longitudinal ligament and bulky right paracentral osteophytosis causes severe bony canal stenosis centered at C5 level resulting in cord compression

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