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

Abstract

<jats:p>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.</jats:p>

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

“…As symptomatic upper cervical cord compression and cervical OPLL occur simultaneously is quiet uncommon, there are only 12 studies (50 cases) reported in the English literature till today [ 6 , 7 , 13 , 16 – 24 ] (Table 3 ). Thus, the radiographic manifestations, as well as the surgical outcome of this disease, remain unclear.…”

“…[ 4 , 5 ] Until now, only a few cases of upper cervical cord compression have been reported. [ 6 , 7 ]…”

“Dynamic” Rotational Canal Stenosis Caused by Osteoma of the Atlas: A Case Report and Review of Literature

“…In previous reports, canal stenosis at the level of the atlas was diagnosed by dynamic myelo-CT scan, 16) dynamic MRI, 22) or both of them 17) when no cause for myelopathy was detected with CT scan or MRI in the neutral position. Recent study reported that MR myelography can achieve a reliable diagnosis of lumbar spinal stenosis compared with CT myelogram.…”