An unusual case of paraparesis due to hypertrophy of posterior longitudinal ligament at thoracic and lumbar spine with long-term follow-up: a case report and literature review.
Basit A Syed, Jimena Gonzalez-Salido, Naveen Arunachalam Sakthiyendran et al.
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Case in brief
A 50-year-old man presented with rapidly progressive paraparesis and gait disturbance. Imaging revealed a continuous, non-ossified lesion from T5 to L4 causing severe spinal cord compression. The patient underwent surgical resection and fusion, leading to full neurological recovery. Long-term follow-up showed persistent non-ossified hypertrophy of the posterior longitudinal ligament without recurrence, alongside new anterior longitudinal ligament hypertrophy.
What made this case unusual
This case is notable for the absence of ossification in a diffuse thoracolumbar hypertrophy of the posterior longitudinal ligament, which is typically associated with ossification in similar cases.
Diagnostic / clinical pearl
Clinicians should consider hypertrophy of the posterior longitudinal ligament as a potential cause of spinal cord compression, even in the thoracic and lumbar regions, particularly when imaging shows non-ossified lesions.
Why it matters
Understanding the distinct biological pathways of hypertrophy of the posterior longitudinal ligament versus ossification can inform management strategies and improve long-term patient outcomes.