Tetraplegia after atrial fibrillation ablation: a rare complication due to unrecognized cervical ossification of the posterior longitudinal ligament

Catheter ablation is widely regarded as a safe and effective treatment for atrial fibrillation (AF). However, rare but severe complications may occur, particularly in patients with undiagnosed structural abnormalities. A 60-year-old man with paroxysmal AF developed complete tetraplegia following catheter ablation under moderate sedation. The procedure was uneventful; however, the patient immediately developed profound quadriparesis. An urgent cervical spine Magnetic Resonance Imaging revealed extensive mixed-type ossification of the posterior longitudinal ligament (OPLL) from C2 to T2 with severe spinal cord compression at C5 and intramedullary high-signal changes, indicating acute compressive myelopathy. Despite emergent decompressive laminectomy and fusion, the patient remained tetraplegic with American Spinal Injury Association grade A status. No neurological improvement was noted at the two-year follow-up. This case underscores the importance of recognizing occult cervical spine pathology, such as OPLL, as a risk factor for spinal cord injury during procedures involving neck positioning or sedation. Preprocedural cervical imaging is warranted in high-risk individuals to prevent catastrophic outcomes. To the best of our knowledge, this is the first reported case of irreversible tetraplegia due to undiagnosed OPLL following AF ablation.