Ossification of the posterior longitudinal ligament (mixed type)
Middle aged female with back pain and increasing spastic paraparesis.
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Heavily ossified and thickened posterior longitudinal ligament (PLL) from C4 down to T3 with resultant obliteration of the anterior and posterior CSF column at these levels.
The cervical cord returns a normal homogeneous signal.
The ossified PLL extends further down to T7, but is less pronounced.
At T8/T9 a hypertrophic protuberant ossified PLL produces cord impingement with myelomalacia.
At T11/T12 slightly protuberant ossified PLL produces, but no significant cord compromise.
At L5/S1 degenerative disc disease with central disc protrusion causes compression on both exiting S1 nerve roots.
A rather florid example of ossification of the posterior longituinal ligament (OPLL) with both continuous and segmental disease making this a mixed type of OPLL.
As is most often the case with this condition this patient was of Asian descent.
The patient proceeded to decompressive back surgery.