This study was designed to determine the management strategies and outcomes of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine.

One hundred twenty-one patients with radiologically proven OPLL including early form of OPLL (EOPLL) and hypertrophy of the posterior longitudinal ligament (HPLL) underwent surgical intervention either by the anterior procedure or posterior procedure from 1993 to 2002. The anterior approach with direct removal of OPLL was performed on 111 patients with one- or two-level OPLL, whereas expansive laminoplasty was performed as the choice posterior procedure on 10 cases with extensive OPLL. The surgery-related outcome was excellent or good for 88% and fair for 12%. This clinical improvement correlated well with the severity of the preoperative myelopathy. Two patients underwent the second anterior procedure after expansive laminoplasty. OPLL associated with dural ossification may show cerebrospinal fluid leakage after resection of the OPLL and dural ossification.

One- or two-level OPLL can be resected by an anterior approach with partial corpectomy, whereas expansive laminoplasty is indicated for multilevel compressive myelopathy due to OPLL. EOPLL and HPLL should be carefully examined with radiological workups because they are a prestage form of OPLL.

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