Ossification of the Posterior Longitudinal Ligament: A Case Report of Difficult Intubation in a Resource Limited Setting

Ossification of the posterior longitudinal ligament (OPLL) is a rare and often unrecognized cause of difficult intubation that is most commonly found in elderly Asian males. This case report will describe the airway management of such a patient with severely limited neck mobility. A 66-year-old male with diabetes and hypertension presented with ongoing neck pain over three years and new progressive weakness in all extremities over the last two months. Neurological examination revealed mild spastic paresis and hyperreflexia in both upper and lower extremities. Neck movement was severely restricted and radiographic evidence supported the finding of OPLL. A challenging airway was anticipated and management plans were discussed in advance. A difficult intubation set containing a video laryngoscope and a fiberoptic bronchoscope were prepared for the case. Conventional laryngoscopy was avoided due to severely limited neck mobility and the risk of causing trauma to the spine. The trachea was successfully intubated using video laryngoscopy without manipulation of the cervical spine. The patient underwent a successful posterior decompressive laminectomy with posterior lateral mass screw fixations at C2-C6. OPLL is a rare cause of difficult intubation that can pose a challenge to anaesthesia providers, especially in resource limited settings. Preoperative evaluation and appropriate airway preparation is essential. Our case demonstrates that video laryngoscopy can be a great choice for the management of difficult airways in such patients.