Ossification of the posterior longitudinal ligament: a review of literature.

Ossification of the posterior longitudinal ligament (OPLL) is most commonly found in men, in the elderly, and in Asian patients. The disease can start with mild or no symptoms, but some patients progress slowly to develop symptoms of myelopathy. An accurate diagnosis through the use plain radiograph, computed tomography, and magnetic resonance imaging findings is very important to monitor the development of symptoms and to make decisions regarding a treatment plan. When symptoms are mild and non-progressive, conservative treatments and periodic observations are good enough, but once symptoms of myelopathy are present and neurologic symptoms are progressive, the treatment of choice is surgery to relieve spinal cord compression. Surgical management of OPLL continues to be controversial. Each surgical technique has some advantages and disadvantages, and the choice of operation should be decided carefully with various considerations. The patient's neurological condition, location and extent of pathology, cervical kyphosis, presence or absence of accompanied instability, and the individual surgeon's experience must be an important factors that should be considered before surgery.