Posterior decompression and internal fixation in treatment of hypertrophy of posterior longitudinal ligament at C1-2 level accompanied with lower cervical spinal stenosis

RATIONALE Hypertrophy of posterior longitudinal ligament (HPLL) at C1-2 level accompanied with lower cervical spinal stenosis is rare in clinic. No reports have described HPLL at C1-2 level accompanied with lower cervical spinal stenosis treated by posterior decompression, combined with internal fixation in 1 stage. PATIENT CONCERNS A 70-year-old Chinese female complained of numbness and paralysis in both her hands and right leg for 1.5 years; Cervical vertebra x-rays and magnetic resonance imaging revealed a HPLL at C1-2 and cervical spinal stenosis at C3-6. DIAGNOSES She was diagnosed with cervical spondylotic myelopathy (CSM). INTERVENTIONS The patient underwent posterior decompression from C1 to C5 level, and fixed with C1-2 vertebral pedicle and C3-5 lateral mass of screw. OUTCOMES One week after operation, the patient showed significant improvement in the numbness of her hands. A follow-up cervical vertebra computed tomography showed good location of internal fixation device and correction of cervical spinal stenosis. Twelve months after surgery, the patient showed improvement in preoperative clumsiness and gait disturbance, and no recurrence of the clinical symptoms occurred. LESSONS HPLL at C1-2 level accompanied with lower cervical spinal stenosis caused myelopathy is rare. Cervical posterior decompression and internal fixation is an effective treatment. The surgical outcome is satisfactory.