Case 5 : (MRI)

A 38-year-old male presented with severe neck pain and difficulty in walking of 3 years duration. Following a routine cervical spine radiograph, MRI spine was performed.
What is the diagnosis?

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MRI revealed a large signal-void area posterior to the vertebral bodies in the epidural space extending from C2 to D1 vertebral levels, with compression and posterior displacement of the cord. This lesion appeared to "bloom" indicating the presence of calcification. Additional changes of cervical spondylosis were also detected.



Ossification of posterior longitudinal ligament



Ossified Posterior Longitudinal Ligament (OPLL) is often diagnosed on lateral plain films but is frequently overlooked. CT is more sensitive, and even MRI can be used to evaluate OPLL, especially in suspected spinal cord compression.

OPLL often involves the cervical spine, and gives rise to epidural ossified lesions that may cause radiculopathy. The cause of OPLL has been debated since Tuskimoto’s autopsy description. Fluoride intoxication, diabetes mellitus, growth hormone imbalance, disc protrusion, recurrent minor trauma, abnormal calcium metabolism and infection have all been suggested. A high association has been noted with diffuse idiopathic skeletal hyperostosis (DISH), ligamentum flavum ossification and ankylosing spondylitis. Some argue that OPLL is an autosomal dominant disorder.

Proton density in sagittal plane and all sequences in the axial plane is ideal for diagnosis of OPLL and associated spinal cord compression.



Dr. Deepak Patkar, MRI Nanavati, Mumbai.

Email: drpatkar@bol.net.in


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