A Multidisciplinary Approach to Management of Ossification of the Posterior Longitudinal Ligament: A Case Study

Case Diagnosis: Cervical spinal stenosis secondary to ossification of the posterior longitudinal ligament

Case Description or Program Description: A 56 year old male presented to clinic for evaluation of progressive neck and arm pain. Insidious in onset, his pain worsened over 3 years and ultimately presented for evaluation when he developed subjective hand weakness and began dropping small objects. Physical exam demonstrated intact strength and sensation in bilateral upper extremities, except with diminished sensation on the right 5th digit and lateral aspect of the 4th digit.

Setting: Outpatient

Assessment/Results: Plain radiographs demonstrated a linear density posterior to the vertebral body consistent with ossification of the posterior longitudinal ligament (OPLL). CT scan confirmed the findings, demonstrating near fusion of the osteophyte complexes at C5-6 and C6-7. MRI demonstrated spinal cord compression and posterior displacement at C6-7. Electromyography and nerve conduction studies were negative for myelopathic changes.

Following diagnostic confirmation, the patient opted for nonoperative management with close monitoring under a multidisciplinary team including physiatry, neurosurgery, and physical therapy. The patient experienced symptomatic relief with epidural steroid injection, gabapentin, and therapy focused on cervical traction. At one-year follow up, the patient reported sustained improvement in his symptoms and showed no evidence of disease progression.

Discussion (relevance): Ossification of the posterior longitudinal ligament is a rare and poorly understood phenomena that often requires surgical intervention in severe cases. This case highlights the role of a multidisciplinary, nonoperative approach in managing OPLL in select patients. Systematic reviews suggest that in the absence of initial myelopathy, approximately 83% of patients managed nonoperatively do not experience progression, but careful monitoring is still required as patients remain at elevated risk for cervical spinal cord injury.

Conclusions: Ossification of the posterior longitudinal ligament is a rare condition that can result in cervical stenosis and myelopathy. This case highlights the value of a multidisciplinary and tailored approach to OPLL management.