A Case of Sleep Apnea Syndrome Caused by C1-2 Ossification of the Anterior Longitudinal Ligament

While rare, ossification of the anterior longitudinal ligament (OALL) of the cervical spine can cause dysphagia, dyspnea, and dysphonia. There are no case reports of sleep apnea syndrome (SAS) caused by OALL of C1-2 in the cervical spine. Here, we report a case of surgical treatment for massive C1-2 OALL leading to severe sleep apnea. A 46-year-old man presented with gradually progressing SAS secondary to OALL. Flexible laryngoscopy revealed a protruding posterior wall in the middle pharynx. Overall apnea-hypopnea index was 50.5 events/hour. Lateral cervical X-ray and computed tomography (CT) showed massive OALL from C1 to C2 and stenosis of the nasopharynx. A microscopic transoral approach was utilized to remove the OALL with a bone rongeur and a high-speed drill. Postoperatively, SAS was significantly reduced, and the quality of life improved. In conclusion, we suggest that surgical management of symptomatic upper cervical OALL will prevent secondary complications of SAS, and improve the quality of life.