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50 yo/M patient presents with non-specific neck disomfort.

No prior trauma,  surgeries,  carcinoma orcorticosteroid/opioid regimen reported.

What do you see?

Cervical spine- lateral

Cervical spine- close up exam.

The C2 disc shows annular calcification. Spondylosis/DISH like change is seen at C4-5 motor unit with  degenerative disc disease at C5.

  The keys finding is the thin vertical density posterior to the C2-4 levels involving posterior longitudinal ligament. This is best seen on the close -up view.

Stages of spinal cord damage by OPLL
  • stage 0: normal or mild compression of the anterior horn without neuronal loss
  • stage 1: mild compression of the anterior horn with partial neuronal loss
  • stage 2: marked deformity of anterior horn; severe neuronal loss
  • stage 3: severe spinal cord damage

T2-weighted sequences are considered the most effective in the evaluation of spinal cord compression. (1) Radiopaedia.com

The  axial CT scan – bone window shows OPLL which causes mass effect on the cord. (4) mrimedicvn.blogspot

DISCUSSION: The mass effect of the OPLL seen on the axial CT image may causes stages of cord damage described by Radiopaedia.com seen above. The cases of OPLL that occupy 30-60% of the cross-sectional diameter are more likely to show myelopathy. Laterally deviated OPLL masses have a higher risk of myelopathy than those at the midline (5)

REFERENCES:

  1. https://radiopaedia.org/articles/ossification-of-the-posterior-longitudinal-ligament
  2. https://bmcmusculoskeletdisord.biomedcentral.com/track/pdf/10.1186/s12891-018-2227-z.pdf
  3. Mader R, Baraliakos X,
    Eshed I, et al. Imaging of DISH). RMD Open 2020;6:e001151. doi:10.1136/ rmdopen-2019-001151
  4. http://mrimedicvn.blogspot.com/2011/04/posterior-spinal-ligaments-ossification.html 
  5. https://radsource.us/ossification-posterior-longitudinal-ligament-bone-bad-place/