Nordin, Muhammad Shukri and Abu Hasan, Muhammad Abdus-Syakur (2025) Unveiling the hidden culprit: ossification posterior longitudinal ligament (OPLL) with central cord syndrome in a post - traumatic diparesis patient. In: Tripartite Congress 2025: 58th Malaysia-Singapore Congress of Medicine, 5th AMM-AMS-HKAM Tripartite Congress of Medicine & 7th Emergency Medicine Annual Symposium (EMAS), 22nd August 2025, Kuala Lumpur, Malaysia.
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Abstract
Introduction: Ossification of the posterior longitudinal ligament (OPLL) is uncommon condition characterized by abnormal calcification of the ligament along the spinal column, most commonly in the cervical region. While it typically affects older adults, its presence in younger individuals is unusual and can increase the risk of spinal cord injury (SCI) even with minor trauma. This case report highlights a patient with traumatic central cord syndrome (CCS) in the context of OPLL, emphasizing the importance of early identification and management. Case Description: A 41-year-old male immigration officer fell into a 4-foot-deep drain while restraining an immigrant, landing with neck in a hyperflexion position. He experienced immediate weakness in all four limbs, with spontaneous resolution in the lower limbs after five minutes, while upper limb weakness persisted. In the emergency department, he was hemodynamically stable, with motor weakness (left 3/5, right 4/5) and sensory deficits in the C5-T1 region. Cervical x-ray was clear. CT imaging revealed OPLL from C2 to C6, and MRI confirmed multilevel disc prolapses and spinal stenosis at the C3-C5 levels. The patient was diagnosed with traumatic CCS with underlying OPLL and underwent posterior cervical laminoplasty. Discussion: OPLL is a well-known but often asymptomatic condition that predisposes patients to cervical spinal stenosis and increases susceptibility to SCI even after minor trauma. Although CCS is typically linked to hyperextension injuries, this case is unique due to the hyperflexion mechanism and the patient’s relatively young age. The incidental finding of OPLL highlights the need for comprehensive imaging in patients with unexplained neurological deficits. Early surgical decompression has been shown to improve outcomes in patients with CCS, particularly when pre-existing spinal abnormalities are present. Conclusion: This case underscores the importance of recognizing OPLL as a potential risk factor for traumatic SCI, even in younger patients and non-typical injury mechanisms. Early diagnosis through advanced imaging, prompt cervical immobilization, and timely surgical intervention are crucial in optimizing patient outcomes. Further research is needed to explore the underlying causes of early-onset OPLL and to facilitate earlier identification in emergency settings.
| Item Type: | Proceeding Paper (Poster) |
|---|---|
| Additional Information: | 9503/122999 |
| Uncontrolled Keywords: | Ossification of posterior longitudinal ligament, spinal cord injury, central cord syndrome |
| Subjects: | R Medicine > R Medicine (General) R Medicine > RD Surgery > RD701 Orthopedics R Medicine > RD Surgery > RD93 Emergency Surgery. Wounds and Injuries |
| Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button): | Kulliyyah of Medicine > Department of Emergency Medicine Sultan Ahmad Shah Medical Centre (SASMEC) Kulliyyah of Medicine |
| Depositing User: | Dr. Muhammad Abdus-Syakur Abu Hasan |
| Date Deposited: | 02 Sep 2025 09:50 |
| Last Modified: | 02 Sep 2025 09:51 |
| URI: | http://irep.iium.edu.my/id/eprint/122999 |
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