Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: Etiology, Clinical Presentation, and Management

» Ossification of the posterior longitudinal ligament (OPLL) is a hyperostotic condition that results in ectopic bone formation and calcification of the posterior longitudinal ligament. » OPLL can present in any race/ethnicity but historically has been reported in the East Asian population. » OPLL predisposes patients to spinal cord injury in the setting of minor trauma. » Asymptomatic patients typically can be managed nonoperatively. Surgical treatment is reserved for patients presenting with myelopathy and worsening radiculopathy that has not responded to conservative treatment. » The decision to use anterior, posterior, or combined anterior-posterior approaches should be an individualized decision that considers the degree of OPLL pathology, K-line imaging findings, and other patient-specific risk factors.