Innovative application of the expanded shelter technique in C2-involving cervical OPLL: a case report.

BACKGROUND CONTEXT: Ossification of the posterior longitudinal ligament (OPLL) involving the C2 segment poses significant surgical challenges due to anatomical complexity and limited exposure.

PURPOSE: This report describes a novel application of the Expanded Shelter Technique to overcome C3-level exposure constraints in the management of continuous C2-C6 OPLL.

STUDY

DESIGN

This study used a clinical case report.

RESULTS

A 60-year-old male presented with progressive neck/shoulder discomfort, right upper limb numbness, and weakness (MRC grade 2 right vs. grade 4 left). Imaging showed multi-level OPLL from C2 to C6, severe canal stenosis, and disc herniations. The Expanded Shelter Technique was performed. Neurological symptoms in the right upper limb resolved on the first postoperative day, with no new neurological symptoms emerging. At the six-month follow-up, neurological symptoms remained absent, and solid bony fusion was confirmed at the graft-vertebral interface. Direct spinal cord decompression was achieved. Subtotal resection of the C3 vertebral body effectively widened the surgical corridor and reduced procedural complexity.

CONCLUSIONS

We report a case of continuous cervical OPLL spanning C2-C6 managed with the Expanded Shelter Technique. This approach successfully overcomes C3 exposure constraints through subtotal vertebral body resection and mesh reconstruction, providing a viable anterior decompressive solution for this challenging OPLL subtype.