{"id":"a40a9ae6-1666-41c1-b9d3-e151d54b0980","slug":"posterior-longitudinal-ligament-and-its-implications-in-intradural-cervical-disc-herniation-case-report-and-review-of-the-literature","title":"Posterior longitudinal ligament and its implications in intradural cervical disc herniation: Case report and review of the literature","authors":["Christian Brogna","José Pedro Lavrador","Sabina Patel","Francesco Vergani","Sanjeev Bassi","Gordan Grahovac","Ranjeev Bhangoo","Keyoumars Ashkan"],"abstract":"Background: Intradural disc herniations (IDH) are rare, particularly in the cervical spine, where they account for less than 5% of all discs. Adhesions between the ossified/calcified posterior longitudinal ligament (OPLL), dura, and ossified/calcified disc herniations increase the complexity of resecting these cervical lesions. Case Description: A 42-year-old male presented with a rapidly progressive cervical myelopathy over a 2-month period. This was attributed to an ossified/calcified intradural cervical disc herniation in conjunction with OPLL. The anterior cervical discectomy and fusion (ACDF) resulted in a dural defect but there was no cerebrospinal fluid (CSF) fistula as the arachnoid membrane remained intact. Had there been a CSF leak, it would have warranted both wound-peritoneal (WP) and lumbo-peritoneal shunts (LP). The surgeons should have anticipated that a CSF leak would likely occur prior to performing the ACDF, and should have prophylactically prepared and draped the abdomen for a potential WP, followed by a LP shunt. Three months postoperatively, the patient's proprioceptive deficit improved, and he almost completely recovered motor function. Conclusion: Performing an ACDF for resection of an intradural calcified/ossified disc with OPLL often results in both a dural defect and CSF fistula. As the arachnoid membrane rarely remains intact, the spine surgeon should be prepared to immediately perform both a WP shunt, and subsequently, an LP. In this case, following an ACDF, resection of an intradural ossified disc with OPLL resulted in an isolated dural defect without a CSF fistula and did not require no dural repair or shunting procedures.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/a40a9ae6-1666-41c1-b9d3-e151d54b0980/featured/hero-1782420869127.png","publishDate":"2018-06-18T00:00:00.000Z","doi":"10.4103/sni.sni_29_18","categories":["Spine","Case Report"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2018/06/8899/SNI-9-119.pdf"}