Cervical amyotrophy caused by hypertrophy of the posterior longitudinal ligament

Abstract

Study design: A case report. Objectives: To report a case of cervical amyotrophy caused by hypertrophy of the posterior longitudinal ligament (HPLL). Setting: Department of Neurological Surgery, Aichi Medical University, Aichi, Japan. Methods: The patient had severe muscular atrophy in the deltoid and triceps with slight localized hypesthesia in the C5 area and severely unstable gait due to diminished vibration sense in the knees and ankles. Magnetic resonance imaging (MRI) showed expanded cord compression from C4 to C6 with intramedullary high-signal intensity due to HPLL. Transverse image MRI was useful to identify the HPLL. Results: Resection of HPLL was achieved by an anterior approach. Histological findings of the surgical specimens showed thickening of the ligamentous tissue with proliferation of chondrocytes. Conclusions: HPLL should be included as a causative pathology of cervical spondylotic amyotrophy. Careful neurological examination including sensory examination of the lower limbs should be performed to avoid confusion with motor neuron disease.