AGE
Seventies
CONDITION
Cervical myelopathy
CAUSE
Extensive OPLL
treatment
Posterior decompression
Aim
Halt progression
Presentation
A lady in her seventies noticed her hands becoming clumsy and her walking less steady, symptoms that had been slowly progressing. These are the signs of cervical myelopathy, where the spinal cord in the neck is compressed, and they are easily mistaken for ordinary ageing.
Investigation
The cause was ossification of the posterior longitudinal ligament (OPLL), a hardening of the ligament that narrows the spinal canal. While OPLL is more commonly seen in people of Asian descent, its prevalence in the Caucasian population remains understudied. Here it was extensive enough to be seen clearly on X-ray, without the need for a CT scan.
Shared decision
Non-surgical treatment cannot widen a narrowed spinal canal, so where myelopathy is progressing, decompression is usually advised without prolonged delay. The aim was explained honestly: to halt the decline and protect the cord, with any recovery of function a hoped-for bonus rather than a promise.
Treatment
A posterior cervical decompression was carried out. Afterwards, the patient experienced a transient weakness in the C5 myotome on one side, a rare occurrence compared with the recognised complication of bilateral C5 palsy after long posterior cervical decompression and fusion. An immediate MRI was performed to rule out a haematoma, and confirmed successful decompression with the cerebrospinal fluid column restored around the cord. The arm weakness improved within a matter of hours.
Outcome
The primary aim in myelopathy is to halt progression. In this case, not only was further deterioration prevented, but the patient also reported some improvement in hand function after one year.
