Atlantoaxial Subluxation Associated With Ossification of Posterior Longitudinal Ligament of the Cervical Spine

Takasita, Mitsuhiro; Matsumoto, Hirofumi; Uchinou, Shouichi; Tsumura, Hiroshi; Torisu, Takehiko

doi:10.1097/00007632-200008150-00019

Cited by 8 publications

(4 citation statements)

References 8 publications

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“…16 The occipitoatlantoaxial joint accounts for 45° of flexion and extension. 13 However, in our case, the movement almost disappeared, and it was therefore impossible for the compensatory mechanism of the occiput-C1 joint to function.…”

Section: Discussionmentioning

confidence: 51%

Upper cervical cord compression due to a C-1 posterior arch in a patient with ossification of the posterior longitudinal ligament and a kyphotic cervical spine in the protruded-head position

Takeuchi¹,

Wakao

Kamiya

et al. 2013

SPI

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In this paper the authors report the case of a patient with ossification of the posterior longitudinal ligament (OPLL) below the axial vertebra (C-2) at the kyphotic cervical spine, with an atlas vertebra (C-1) posterior arch that compressed the spinal cord with the head in a pathognomonic position, similar to a protruded position. This condition appears to be very rare. The morphological findings between the kyphotic cervical spine and OPLL, the upper occipitocervical junction, and the protruded-head position are discussed. A 40-year-old man presented with severe pain radiating to both legs when he yawned, sneezed, or extended his jaw (a protruded-head position). A kyphotic cervical spine with OPLL below C-2 was observed using CT and radiography, yet sagittal T2-weighted MRI failed to identify abnormal findings in a neutral or extension position, except for a slight cervical canal stenosis. However, in a pathognomonic protruded-head position, sagittal T2-weighted MRI showed a C-1 posterior arch that severely compressed the spinal cord at the upper cervical level. Therefore, the authors believe that the severe pain radiating to both legs was caused by a spinal canal stenosis due to a C-1 posterior arch impingement. The C-1 posterior arch was resected, and after the surgery, the patient indicated that the intolerable pain had disappeared. In conclusion, in patients with OPLL and a kyphotic cervical spine, the authors propose that the pathognomonic protruded position is valuable for estimating disrupted compensatory mechanisms at the upper cervical junction.

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Section: Discussionmentioning

confidence: 51%

Upper cervical cord compression due to a C-1 posterior arch in a patient with ossification of the posterior longitudinal ligament and a kyphotic cervical spine in the protruded-head position

Takeuchi¹,

Wakao

Kamiya

et al. 2013

SPI

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“…1 From the dynamics radiographs, we estimated the patient has no instability at the craniocervical segment 19 , and thus laminectomy from C1 to C3 without occipitoatlantal arthrodesis was performed. The previous reports suggested the necessity of rigid fixation of the cervical spine 20 , but, we had not recognized any further problems without performing arthrodesis in this case.…”

Section: Cervical Myelopathy By Dishmentioning

confidence: 56%

Cervical Myelopathy by C1 Posterior Tubercle Impingement in a Patient With DISH

Kawabori

Hida²,

Akino³

et al. 2009

Spine

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“…They proposed that fusion of the subaxial cervical spine caused the hypermobility at C1–2, and may lead to the ligamentous damage and upper cervical cord compression. In another study, Takasita et al [ 19 ] suggested that OPLL can affect the cervical biomechanics and restricts the mobility of the lower cervical spine, which causes additional mechanical demand on the atlantoaxial joint and subsequently leads to atlantoaxial subluxation. However, some authors disagreed with this hypothesis and proposed the pathology of combined upper cervical cord compression and cervical OPLL is that upper cervical cord compression occasionally occurred in patients with cervical OPLL.…”

Section: Discussionmentioning

confidence: 99%

Radiological manifestations and surgical outcome of combined upper cervical cord compression and cervical ossification of the posterior longitudinal ligament with a minimum 2-year follow-up

Zhou

Chen

et al. 2017

Medicine

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Combined upper cervical cord compression associated with cervical ossification of the posterior longitudinal ligament (OPLL) is a rare and under-recognized disorder. The aim of this study was to investigate the radiological manifestations and surgical outcome of this combined disease.Between May 2011 and July 2015, patients who underwent surgery for combined upper cervical cord compression and cervical OPLL in our institution were included in this study. After a minimum 2-year follow-up, radiological and clinical data were collected. The etiology of upper cervical cord compression and radiological features of cervical OPLL was determined. Surgical outcome was evaluated with Visual Analogue Scale (VAS), Japanese Orthopedic Association score (JOA), space available for the spinal cord (SAC) at the cephalad adjacent level, occupying ratio of OPLL and cervical lordosis.In total, 24 patients (11 men and 13 women) with a mean age of 57.9 years old were included. The etiology of upper cervical cord compression included craniovertebral junction deformity (n = 10), atlantoaxial subluxation (n = 5), and OPLL extending to C2 level (n = 9). The extent, type, and thickest level of cervical OPLL varied among the patients. Significant improvement of VAS and JOA score was noted postoperatively and at a minimum 2-year follow-up. The result was satisfactory in SAC at the cephalad level and occupying ratio of OPLL. There were no significant differences in C2/C7 lordotic angle at the preoperative, postoperative and the last follow-up examination.In conclusion, the radiological manifestations of combined upper cervical cord compression and cervical OPLL varied among the patients. Satisfied results can be achieved with adequate surgical treatment a minimum 2-year follow-up.

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Atlantoaxial Subluxation Associated With Ossification of Posterior Longitudinal Ligament of the Cervical Spine

Abstract: Ossification of the posterior longitudinal ligament of the cervical spine may cause atlantoaxial subluxation.

Cited by 8 publications

References 8 publications

Upper cervical cord compression due to a C-1 posterior arch in a patient with ossification of the posterior longitudinal ligament and a kyphotic cervical spine in the protruded-head position

Upper cervical cord compression due to a C-1 posterior arch in a patient with ossification of the posterior longitudinal ligament and a kyphotic cervical spine in the protruded-head position

Cervical Myelopathy by C1 Posterior Tubercle Impingement in a Patient With DISH

Radiological manifestations and surgical outcome of combined upper cervical cord compression and cervical ossification of the posterior longitudinal ligament with a minimum 2-year follow-up

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