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Ultra-early onset of ossification of the posterior longitudinal ligament with congenital rickets

Ossification of the posterior longitudinal ligament (OPLL) is a condition caused by progressive and abnormal calcification of the posterior longitudinal ligament in the cervical and thoracic spine, leading to gradual compression of the spinal cord. The exact pathogenesis of OPLL is unclear; however, the interaction of genetic and environmental factors such as mechanical stress of the ligaments is speculated to result in the pathogenesis of OPLL.1 OPLL has an incidence of 1.9% to 4.3% in Japan and 0.01% to 1.7% in Europe; males are twice as likely to have OPLL as females, and the average age at onset is older than 50 years.1 OPLL is known to have a strong genetic predisposition, and a prevalence of 29% in siblings has been demonstrated.2 The majority of cases are idiopathic and typically present in the fifth or sixth decades. However, in rare occasions, OPLL can be associated with endocrine abnormalities and may present at a much younger age.2 We report a case of a 26-year-old woman with congenital X-linked hypophosphatemic rickets (XLHR) who was diagnosed with severe OPLL.