Ossification of the Posterior Longitudinal Ligament (OPLL): Symptoms, Treatment


Ossification of the posterior longitudinal ligament (OPLL) refers to a condition in which bone forms within the posterior longitudinal ligament. The posterior longitudinal ligament is a flexible structure, connecting and stabilizing the bones of the spinal column.

When the posterior longitudinal ligament becomes thicker and less flexible, ossification of the posterior longitudinal ligament occurs. Although the posterior longitudinal ligament runs almost the entire length of the spine, the condition most often occurs at the spine in the neck or the cervical spine.

Moreover, there is a considerable racial variation in the prevalence of ossification of the posterior longitudinal ligament. The condition is most often seen in people of Asian descent. According to studies, the incidence ranges from 1.9% to 4.3% in the Japanese population. In non-Asians, the prevalence is only 0.16%.

Overall, the condition often presents in the fifth and sixth decades of life. Men and the elderly are more likely to develop the condition. According to statistics, ossification of the posterior longitudinal ligament is twice as common in men as in women.

75% of the condition occurs in the cervical region while only 10% to 15% of the disease happens in the middle and lower back, or the thoracic or lumbar region.


Right now, the precise cause of ossification of the posterior longitudinal ligament remains unknown. But according to the current researches and studies, the condition may have relations with diabetes mellitus and generalized hyperostosis of the spinal ligaments such as diffuse idiopathic skeletal hyperostosis.

Moreover, experts have found that genetic factors may also play a role in getting the disease. Patients with ossification of the posterior longitudinal ligament have reported an abnormality in the N-propeptide of the COL 11A2 gene that is related to Type II collagen.


Most people with ossification of the posterior longitudinal ligament show mild or no symptoms. In often cases, the symptoms of the condition progress slowly. Common signs and symptoms of ossification of the posterior longitudinal ligament may include the following:

  • Pain and numbness in the arms and legs
  • Tingling
  • Dysesthesia
  • Motor dysfunction in extremities
  • Loss of bladder control
  • Clumsiness
  • Abnormal reflexes
  • Spastic gait
  • Spastic paresis in the arms and legs

Symptoms of the condition may vary from person to person. So, if you have the above-described symptoms, you should go to the hospital and get a definite diagnosis as soon as possible.


To make a diagnosis, a doctor usually conducts a careful physical examination first. In this procedure, the doctor will check the gait, balance, and reflexes for the individual and make a primary diagnosis.

Then, to confirm whether the individual has ossification of the posterior longitudinal ligament or not, imaging tests will be ordered. An X-ray test is commonly used in the initial assessment. With the detailed cervical X-ray images, the doctor can decide whether the individual has the condition and which type of condition the individual has.

Other imaging tests such as CT scans and MRI scans may also be performed to help the doctor to better visualize the situation. These two scanning results can help the doctor to check if the spinal cord and nerve roots are compressed. With this information, the doctor may give out an accurate diagnosis and tailor treatment plans accordingly.


If the patient with ossification of the posterior longitudinal ligament has mild or no symptoms, the condition can be addressed with non-surgical treatment approaches.

Since people with mild or no symptoms usually only suffer from neck pain, the doctor may prescribe some pain relievers and anti-inflammatory medications to ease the symptoms. Besides, physical therapy may also be useful for patients to strengthen their muscles in the back and reduce some of the symptoms.

However, if the symptoms continue to progress and there appear signs and symptoms of myelopathy or compression of the spinal cord, surgery will usually be recommended by the doctor.

The doctor will decide the best treatment for each individual in line with his or her specific situations. Generally, a cervical laminectomy may be performed in conjunction with a fusion procedure.

Keywords: ossification of the posterior longitudinal ligament; OPLL.

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* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.