OSSIFICATION OF

POSTERIOR
LONGITUDINAL
LIGAMENT

POSTERIOR LONGITUDINAL
LIGAMENT

Situated within the vertebral canal and extends along the

posterior surfaces of the bodies of vertebrae

Spans from the body of the Axis (C2) to the posterior surface of
the sacrum

Functions to prevent hyperflexion of the vertebral column

Ossification = bone tissue formation from a cartilage

OPLL is a calcification of the soft tissues that connect the spinal

bones which results in a narrowing of the spinal canal and
compression of the cervical spinal cord.

Most common levels are C4-C6

Common cause of cervical myelopathy

Most patients with OPLL are asymptomatic with no symptoms at

all, but others may experience mild pain and numbness in the
arms and/or legs to complete numbness in the extremities. Most
symptomatic patients with OPLL present with neurological
deficits such as myelopathy, radiculopathy, and/or bowel and
bladder symptoms.

OPLL is often associated with several other entities

diffuse

idiopathic skeletal hyperostosis (DISH)

ossification

of the ligamentum flavum(ossification of the yellow

ligament (OYL))
ankylosing

spondylitis

Stages of spinal cord damage

by OPLL

stage 0: normal or mild compression of anterior horn without

neuronal loss

stage 1: mild compression of anteriorhorn with partial neuronal

loss.

stage 2: marked deformity of anterior horn; severe neuronal

loss.

stage 3: severe spinal cord damage

Management can range from being conservative to surgical

removal.

Surgical options can include anterior, posterior or combined

approach.

An anterior approaches (plated multilevel anterior discectomy

and fusion, anterior cervical corpectomy with fusion (ACF)), may
provide more direct decompression and best improve
myelopathy. The soft-tissue morbidity associated with the
anterior approach may be greater.

Posterior approaches (e.g. laminectomy and fusion and

laminoplasty) may be better tolerated in older patients.