A late presentation of extensive segmental ossification of the posterior longitudinal ligament: A case report and literature review

Abstract

Ossification of the posterior longitudinal ligament (OPLL) is a rare disorder in North America, mainly presenting in elderly males. It typically involves the cervical vertebrae but may be multi-level on rare occasions. We present a case of a 48-year-old Caucasian lady with a history of type 2 diabetes mellitus, obstructive sleep apnea and morbid obesity presenting with one year of progressive low back pain accompanied by gait instability and recurrent falls. Imaging of her spine revealed extensive multilevel stenosis due to OPLL in the cervical, thoracic and lumbar region due to facet arthropathy and ligamentum flavum thickening. The patient underwent a C4-T2 laminectomy with mobility complications following surgery. Despite appropriate deep venous thrombosis (DVT) prophylaxis and perioperative management, she suffered a massive pulmonary embolism on postoperative day 6 that proved to be fatal. Here, we report this rare, late presentation of extensive segmental OPLL and the dilemma that late detection can present with regard to surgical management.

Keywords

• Continuous OPLL
• Myelopathy
• Ossification of longitudinal ligament