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Abstract: This 58-year-old woman had been suffering from cervical spondylosis for many years but had not paid attention to it until recently when she came to the hospital with symptoms such as urinary and fecal disorders and unstable walking. After surgery to relieve the compression of the nerve spinal cord, the patient’s symptoms improved significantly and her walking basically returned to normal.
Basic information】Female, 58 years old
Disease Type】Spinal ligament ossification
Hospital】The First Hospital of Harbin Medical University
Date of Consultation】October 2021
Treatment plan】Surgical treatment (posterior cervical single-opening spinal canal enlargement surgery)
Treatment period】2 weeks of inpatient treatment and regular outpatient follow up
Treatment effect] Improvement in limb strength and walking function
I. Initial consultation
The patient, a 58-year-old female farmer, reported that her cervical spine had been bad for more than 10 years, and in the last 2 months, she gradually developed weakness in her limbs, unstable walking, and in severe cases, she could not hold chopsticks and always drew circles when walking. When we first saw the patient, the patient had basically no mobility in the cervical spine, and when turning his head, he needed to turn his head and chest together, and his limbs were not only weak, but also had increased muscle tone and strong positive pathological signs, all of which indicated that the patient had more serious cervical spondylosis. The patient was diagnosed with ossification of the spinal ligament, which could be observed through the cervical frontal and lateral radiographs, and there were obvious ossified ligaments at the posterior edge of the patient’s cervical vertebral body.
II. Treatment process
After the patient was admitted to the hospital, further improvement of the cervical spine CT and cervical spine MRI examination revealed that the patient had ossified cervical ligaments leading to spinal nerve compression. The ossified ligament had encroached on approximately two-thirds of the spinal canal, and the patient showed signs of severe cervical spinal stenosis and significant ischemia in the spinal cord. Due to the high risk and difficulty of removing the ossified ligament directly from the front of the spinal cord, which could easily aggravate the spinal cord injury, the patient underwent posterior cervical canal enlargement surgery on the third day after admission to achieve indirect decompression by expanding the volume of the spinal canal. The drainage tube was removed on the 3rd day after surgery, and the incision was changed once every other day, and the stitches were removed 1 week after surgery.
III. Treatment results
The patient’s incision did not show any infection or necrosis after surgery, and the patient’s incision basically healed without infection or blood leakage after about 2 weeks of hospitalization, so the patient was discharged home for recuperation after stitch removal.
The patient was able to walk with the guardrail when he was discharged from the hospital. One month after the surgery, the patient said he felt that his limbs were much more relaxed and flexible, but he still had some drift in walking and his hands were still not very flexible in holding things. Although the ossified ligaments still existed, the internal volume of the vertebral canal was more spacious than before, and the walking posture was basically normal at 6 months after surgery.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but we need to advise the patient that he still needs to wear a neck brace after discharge from the hospital until he has fully recovered and avoids excessive range of motion of the cervical spine, and the neck brace can be removed after 6 weeks. X-rays are required at 3 months, 6 months and 1 year after surgery, and a cervical spine MRI can be taken 2 years after surgery to review the spinal cord. After removal of the cervical brace, the cervical spine can move freely, but cervical spine trauma needs to be avoided. In daily life, it is necessary to avoid movements that are unfavorable to the cervical spine, such as sitting for a long time and lowering the head, so as not to affect the recovery of the disease or cause a recurrence of the disease.
V. Personal insight
Spinal ligament ossification generally has a long history, and because of the presence of cervical stiffness, patients often mistake it for a drop pillow or fasciitis. In this case, when the patient came to see the doctor, only about one-third of the spinal cord was already compressed, and because of the ischemic changes in the spinal cord, surgery could only expand the volume of the spinal canal and indirectly relieve the spinal cord from compression, and it was difficult to remove the ossified ligament directly, and it was even more difficult to treat the spinal cord lesion itself. Although the patient feels better after surgery, the nerve damage is not fully recovered.