PMC5835278_01
Esophagography showing prominent ossification of OALL compressing the esophagus and trachea.
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Esophagography revealed barium retention at the laryngeal part of the pharynx (Figure 1) and anterior displacement of the esophagus and trachea at C4-5 due to OALL, although swallow motility otherwise appeared normal.
Sagittal (a) and axial (b) image of CT showing extensive OALL at C4-5.
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Computed tomography (CT) revealed the prominence of the OALL accompanied with displacement of the esophagus at C4-5 (Figures 2(a) and 2(b)).
Sagittal CT image after removal of OALL.
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However, her swallowing function did not improve, so, unavoidably, we performed an osteophytectomy using a left anterolateral transcervical approach 6 weeks after the tracheostomy (Figure 3).
Magnetic resonance imaging after removal of OALL showing spinal canal stenosis due to ossification of the posterior longitudinal ligament at C4-5.
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Clinical examination revealed muscle weakness in the upper limbs (shoulder abduction, elbow flexion, and elbow extension of 2/5, 3/5, and 4/5, resp.). Cervical magnetic resonance imaging (MRI) showed spinal stenosis at C4-5 due to ossification of the posterior longitudinal ligament (OPLL) and a signal intensity change of the interverbral disc of C5-6 (Figure 4).
Sagittal CT showing an osteolytic and destructive change at the C4 and 5 vertebra and local kyphosis.
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The 6-week follow-up CT findings indicated an osteolytic change at the C4 and 5 vertebra and partial kyphosis at this level (Figure 5).
Plain radiography 1 year postoperatively. (a) AP view and (b) lateral view.
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She underwent debridement, anterior spinal fusion using iliac bone graft (C3-6), and posterior spinal fusion using lateral mass screws and pedicle screws (C2-7) (Figures 6(a) and 6(b)). Spinal stabilization was established one year after the surgery (Figure 6) with obvious bone union confirmed on CT.