summary Ossification of the posterior longitudinal ligament (OPLL) is an idiopathic cervical spine anomaly that is a common cause of cervical myelopathy in the Asian population Diagnosis is made with lateral radiographs of the cervical spine. CT scan is the study of choice to determine the extent and thickness of the ossification Treatment is observation in patients with minimal symptoms. Surgical decompression followed by stabilization is indicated for patients with myelopathy Epidemiology Demographics Asian (most common, but not limited to) men are more commonly affected than women Anatomic location most common levels are C4-5 and C5-6 95% of ossification is located in the cervical spine Etiology Pathophysiology cause is unclear, but likely multifactorial associated factors include: login to view 5 more bullets Presentation Symptoms often asymptomatic myelopathic symptoms Physical exam myelopathy Imaging Radiographs lateral radiograph often shows ossification of PLL used to evaluate the sagittal alignment of cervical spine MRI study of choice to evaluate spinal cord compression CT study of choice to delineate the bony anatomy of the ossified posterior longitudinal ligament Treatment Nonoperative observation login to view 1 more bullet Operative direct or indirect surgical decompression, followed by stabilization login to view 2 more bullets Techniques Interbody fusion without decompression indications login to view 1 more bullet technique login to view 1 more bullet Anterior corpectomy with or without OPLL resection indications login to view 1 more bullet technique login to view 1 more bullet Posterior laminoplasty or laminectomy with fusion indications login to view 2 more bullets techniques login to view 1 more bullet complications login to view 1 more bullet Complications Recurrence of OPLL reduced with login to view 2 more bullets