Ossification of the posterior longitudinal ligament (mixed type)
Presentation
Middle aged female with back pain and increasing spastic paraparesis.
Patient Data
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.
Case Discussion
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.
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