What’s the Diagnosis – Case 154
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What’s the Diagnosis – Case 154
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As this case is a bit more of an “eye test” than many others, want to give just a second pause to allow people to make the diagnosis.
What’s the Diagnosis – Case 154
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Again, just another pause to make the diagnosis before the next set of images.
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Findings Much more subtle on the radiographs and MRI, and then more conspicuous on the CT images, is the dense ossification running along the posterior aspect of the vertebral bodies. There are areas of continuous bone along the vertebrae and areas of disruption. This bone is appreciated as low signal on all pulse sequences on the MRI. On both the CT and MRI, seen is severe central canal stenosis with findings of myelomalacia particularly seen on the MRI.
What’s the Diagnosis – Case 154
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Diagnosis: Ossification Posterior Longitudinal Ligament (OPLL) As the diagnosis implies, there is bone formation of the PLL. In this case, I thought that presenting the case in this fashion would highlight that even when the amount of OPLL is quite exuberant (as in this case) the radiographs and even the MRI can be difficult in terms of rendering the appropriate diagnosis. The CT, as in this case, is often much more conspicuous. Although frequently thought of in Asian populations and especially the Japanese, I can say that anecdotally we see OPLL in a myriad of individuals from different cultures and ethnicities. The OPLL can be continuous, in disrupted segments, mixed, or very focal. Although the PLL runs throughout the neural axis, OPLL is much more frequently found in the cervical spine. This process can be seen in association with other bone forming processes such as ankylosing spondylitis and DISH (diffuse idiopathic skeletal hyperostosis). When severe and causing mass effect upon the cord, as in this case, surgery can be warranted. In other cases, more conservative measures may suffice. This case is also an amazing example at the body’s capacity to deal with processes when they occur over a long period of time, even when they cause such severe stenosis of the cord. Although this patient is presenting with myelopathic symptoms one would expect that an acute process presenting with this degree of stenosis and cord compression would be catastrophic.
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