0:00

This was yet another patient who

0:02

had a cervical myelopathy.

0:04

A CT scan of the cervical spine

0:06

demonstrates relatively marked

0:09

ossification of the posterior

0:10

longitudinal ligament, beginning at the C3 level

0:13

and extending to the C6-C7 level,

0:16

with marked narrowing of the spinal canal.

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You can just imagine how little space

0:21

there is for the cervical spine to

0:24

course through the C4-C5 disc level and

0:28

posterior to the C4 level.

0:30

Fortunately, the patient had an accompanying

0:33

MRI scan subsequently,

0:35

and it shows the bright signal intensity

0:39

of the spinal cord accounting for that

0:42

myelopathy and the OPLL at C3 and C4

0:47

that is compromising the anterior

0:49

half of the spinal canal.

0:51

This patient subsequently did get

0:53

surgery and decompression,

0:56

but as you can see,

0:57

the spinal cord was already injured and

1:00

shows myelomalacia through that region.

1:03

I want to show this case because it

1:06

actually is a nice example of the

1:09

association of OPLL with ligamentum flavum ossification,

1:14

which can compromise the posterior

1:18

thecal sac in the thoracic spine.

1:20

So we have many of these little areas

1:23

where you have dark signal intensity on

1:25

T2-weighted scanning through

1:27

the thoracic region

1:31

encroaching upon the posterior epidural

1:34

space, and at least in this case,

1:36

even showing some element of high signal

1:39

intensity in the thoracic spinal cord

1:42

opposite one of the areas.

1:45

This is also demonstrated on the axial

1:48

scans where you can see the dark signal

1:52

intensity ossification of the ligamentum flavum

1:56

abutting on the spinal cord and

2:00

encroaching on the thecal sac and the

2:02

posterior aspect of the spinal canal

2:05

from right greater than left,

2:07

for example,

2:09

in this example.

2:10

So, in addition to looking for

2:13

diffuse idiopathic skeletal hyperostosis

2:16

in association with OPLL,

2:18

look at the posterior ligamentous

2:21

complex of the ligamentum flavum and

2:23

note whether or not there is compromised

2:25

of the spinal cord in the thoracic

2:28

region on that basis.