Thoracic Ossification of the Posterior Longitudinal Ligament Identified by Neurological Examination in a Patient Initially Suspected of Lumbar Disc Herniation

To emphasize the importance of clinical evaluation when radiological findings and neurological symptoms are inconsistent, focusing on preventing misdiagnosis.A patient initially diagnosed with L5-S1 herniated intervertebral disc was reviewed.Symptoms of lower limb paraplegia and abdominal sensory abnormalities were assessed using the American Spinal Injury Association (ASIA) impairment scale, manual muscle testing, and whole-spine magnetic resonance imaging to correlate clinical and imaging findings.Imaging revealed extensive ossification of the posterior longitudinal ligament from T2 to T9 with severe myelopathy at T7-8, leading to a revised diagnosis.The patient was classified with an ASIA grade D injury.This necessitated discontinuing conservative treatment and considering surgery.Comprehensive neurological examination is crucial when clinical symptoms and imaging mismatch.This process is essential for establishing an accurate diagnosis and treatment plan.