Neurospine.  2019 Sep;16(3):517-529. 10.14245/ns.1938222.111.

Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications

  • 1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
  • 2Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
  • 3Division of Neurosurgery, Landstuhl Regional Medical Center, Landstuhl, Germany.
  • 4Department of Neurosurgery, Tulane University, New Orleans, LA, USA.


Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM). Decompressive surgery is the standard of care for OPLL and can be achieved through anterior, posterior, or combined approaches to the cervical spine. Surgical correction of OPLL via any approach is associated with higher rates of complications and the presence of OPLL is considered a significant risk factor for perioperative complications in DCM surgeries. Potential complications include dural tear (DT) and subsequent cerebrospinal fluid leak, C5 palsy, hematoma, hardware failure, surgical site infections, and other neurological deficits. Anterior approaches are technically more demanding and associated with higher rates of DT but offer greater access to ventral OPLL pathology. Posterior approaches are associated with lower rates of complications but may allow for continued disease progression. Therefore, the decision to pursue either an anterior or posterior approach to surgical decompression may be critically influenced by complications associated with each procedure. The authors critically review anterior and posterior approaches to surgical decompression of OPLL with particular focus on the complications associated with each approach. We also review the recent work in developing new surgical treatments for OPLL that aim to reduce complication incidence.


Postoperative complications; Neurosurgical procedures; Cervical vertebrae; Spinal diseases; Ossification of posterior longitudinal ligament

MeSH Terms

Cerebrospinal Fluid Leak
Cervical Vertebrae
Decompression, Surgical
Disease Progression
Longitudinal Ligaments*
Neurosurgical Procedures
Ossification of Posterior Longitudinal Ligament
Postoperative Complications
Risk Factors
Spinal Cord Diseases
Spinal Diseases
Standard of Care
Surgical Wound Infection
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