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A case report of a 55-year-old patient with extensive cervicothoracic ossification of the posterior longitudinal ligament (OPLL) that was treated with posterior decompression and fusion.To report the preventive effect of posterior instrumentation on postoperative paralysis in extensive cervicothoracic OPLL.Thoracic myelopathy caused by OPLL in the thoracic spine was treated with operative decompression of the spinal cord via an anterior, posterior, or posterolateral approach. However, the lack of availability for some approaches in specific cases, as well as reports of some problems for each approach, indicates that a lack of consensus still remains regarding the choice of operative procedure.A 55-year-old female with extensive cervicothoracic OPLL presented with progressive numbness in the both hands and a gate disturbance. Cervical laminoplasty, thoracic laminectomy, and posterior fusion were performed with electrophysiologic monitoring of the spinal cord evoked potential.After thoracic laminectomy, the amplitude of spinal cord evoked potential waveforms decreased but recovered after a posterior fusion by instrumentation.Prevention of postoperative paralysis from increasing by posterior instrumentation was shown using neurophysiologic monitoring.

Study design Case reports of patients with cervical myelopathy to hypoplasia of the atlas. Objectives To report cases of cervical myelopathy due to congenital hypoplasia of the atlas and to review the literature. Summary of background data Six previously documented cases of congenital hypoplasia of the atlas as a cause of cervical myelopathy are reported in the literature. Methods Three patient's clinical record and radiologic imaging studies as well as a thorough literature search are reported. Plain radiographs, computed tomography scans, magnetic resonance images, as well as somatosensory-evoked potential changes are displayed. Results Cervical myelopathy developed in three patients who were found to have congenital hypoplasia of the atlas. Laminectomy of C1 provided neurologic improvement in all three patients presented. Conclusion Congenital hypoplasia of the atlas is a rare cause of cervical myelopathy. This report should broaden the radiographic differential diagnosis when seeking an explanation for the signs and symptoms of cervical myelopathy.