Artificial Disc Replacement at C5–C6 for Cervical Canal Stenosis Secondary to OPLL: A Motion-Preserving Approach to a Compressive Pathology: A Case Report
I. Gusti Ngurah Wira Aditya *
Department of Orthopaedic and Traumatology, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Udayana University, Bali, Indonesia.
I. Ketut Suyasa
Department of Orthopaedic and Traumatology, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Udayana University, Bali, Indonesia.
*Author to whom correspondence should be addressed.
Abstract
Background: Cervical canal stenosis secondary to ossification of the posterior longitudinal ligament (OPLL) is a challenging condition that can lead to progressive myelopathy. Although anterior cervical discectomy and fusion (ACDF) is a standard treatment, artificial disc replacement (ADR) offers a motion-preserving alternative. OPLL is listed as a relative contraindication to ADR under current device guidelines, and its use in this setting has been reported in only a small number of published cases worldwide, underscoring the value of additional documented experience. This report describes the use of ADR for focal OPLL at C5–C6.
Case Report: A 59-year-old woman presented with a six-month history of neck pain radiating to the left hand and intermittent tingling in the right hand. Neurological examination revealed right-sided hypoaesthesia at C6 and a positive Lhermitte’s sign. Imaging confirmed cervical canal stenosis at C5–C6 due to focal OPLL. The patient underwent single-level artificial disc replacement. The intraoperative course was unremarkable, and the patient experienced significant postoperative neurological improvement, with muscle strength improving from grade 4 to grade 5 and resolution of Lhermitte’s sign by postoperative day 2.
Discussion: This case illustrates that, in carefully selected patients with single-level focal OPLL and preserved spinal alignment, ADR can provide effective anterior decompression. The motion-preserving nature of the procedure offers potential benefits over fusion, including a reduced risk of adjacent-segment degeneration. The favourable outcome is consistent with recent literature supporting ADR as a potential alternative to ACDF in selected OPLL cases.
Conclusion: Artificial disc replacement may represent a safe and effective motion-preserving surgical option for managing cervical canal stenosis due to focal OPLL in appropriately selected patients. In this case, it was followed by marked early neurological recovery and may offer the potential to reduce long-term adjacent-segment pathology.
Keywords: Ossification of the posterior longitudinal ligament, cervical canal stenosis, artificial disc replacement, cervical disc arthroplasty, motion preservation, degenerative cervical myelopathy, cervical myelopathy, anterior cervical decompression