Symptomatic dyspnoea addressed by excision of ossified anterior longitudinal ligament

Abstract

Ossification of the anterior longitudinal ligament (OALL) in cervical spine is known to cause dysphagia. However, dyspnoea and obstructive sleep apnoea (OSA) due to OALL is a rare entity. A 50-year-old man presented to our clinic 2 years after anterior cervical discectomy and fusion (ACDF) with complaints of dysphagia, dyspnoea and difficulty in sleeping supine. The clinico-neurological examination of patient was normal without any long tract signs. The diagnosis of OALL was made on plain lateral radiographs. Ultrasonic bone cutter was used to convert sessile osteophyte mass into a pedunculated mass. It was then disconnected from the anterior aspect of vertebral bodies with a chisel. The patient showed immediate relief from dysphagia and OSA. Dyspnoea improved over a week and the postoperative change in voice responded well to speech therapy. To the best of our knowledge, this is the first report of dyspnoea due to OALL after ACDF.

Keywords: ear, nose and throat/otolaryngology; neurosurgery; orthopaedic and trauma surgery; sleep disorders (respiratory medicine); spinal cord.

Figure 1

Comparison of cervical spine lateral preop (A), immediate postsurgery (B) and 1 year post-op (C): showing reduction of ossification of the anterior longitudinal ligament at C3–C4.

Figure 2

Comparison of cervical spine sagittal CT scans preop (A) and 1 year postop (B): showing reduction of the continuous massive ossification of the anterior longitudinal ligament at C3–C4.

Figure 3

Comparison of cervical spine axial CT scans at C3 level, pre-op (A) and 1 year post-op (B): showing reduction of the continuous massive ossification of the anterior longitudinal ligament at C3 with no osseous pressure on hypopharyx.

Figure 4

Comparison of laryngoscopic images showing larynx: open in supine position (A) and complete closure in forward flexion of neck (B).