Lecture OPLL progressive
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A 49-year-old woman presented with neck pain and left arm pain following a 2014 C2-C7 laminoplasty and C5-C6 foraminotomy. Imaging showed progression of ossification of the posterior longitudinal ligament (OPLL) at C2-C3. The doctor is considering various surgical options, including removing the C3 plate, fusing C2-C3 to stop disease progression, or performing an additional foraminotomy at C6-C7.
Lecture OPLL progressive
- 2. • 49 year old woman cc: L posterior arm pain L trapezial pain, neck pain, L IF pain • HPI:C2C7 laminoplasty removing half of C2/C7 plates on C3-6, L C5C6 foramenotomy 1/9/14; initial symptoms 2013 were L shoulder pain elbow, forearm, L hand numbness • MEDS: Benicar, HCTZ, Lexapro, Lipitor • SH: RHD mother 4 children, cashier and advocate at Wegmans, married • EXAM: 5’3” 210 lb negative clonus, hoffmans, 0/4 dtr normal motor, normal shoulder exam
- 3. Old images from 2014 postop
- 9. Postop 1/10/14 C2c3 disc space C3 pedicle
- 10. Next are recent images
- 11. 5/11/16: note progression of OPLL at C2C3
- 12. May 2016 note OPLL At c3, flexion view
- 13. c2c3 c3 May 2016 Note increased OPLL at c2c3
- 14. 2014 2016 Compare sagittal images To view progression C2C3
- 15. c6c7
- 16. c5c6
- 17. c4c5
- 18. c3c4
- 19. c2c3
- 20. • Questions: • 1. c2 laminoplasty with plate enough? • 2. remove c3? • 3. fusion to stop progression of disease? • 4. L c6c7 foramenotomy • 5. fusion c2c3, lateral mass screws, fusion c6c7?