Background: Ossification of the posterior longitudinal ligament (OPLL) is a complex multifactorial disease process combining both metabolic and biomechanical factors. There are multiple options for managing cervical OPLL including posterior laminoplasty, laminectomy with or without fusion, anterior corpectomy and circumferential decompression and fusion. The role for surgical intervention and choice of anterior or posterior approach is still controversial.

Objective: This study is designed to determine the management strategies and outcomes of ossification of the posterior longitudinal ligament of the cervical spine.

Methodology: Records of total 60 patients aged 32-74 years, who underwent surgical treatment for continuous or mixed type OPLL between 2010-2025, were retrospectively reviewed. Anterior cervical corpectomy & fusion was performed on 20 patients with one or two level OPLL, whereas laminoplasty was performed on 18 cases & laminectomy with lateral mass fixation on 22 cases. Multiple variables were studied, including demographics, surgical parameters, complications and functional outcomes.

Results: The patients were followed up on an average of 24.05 ± 6.48 months. The VAS score decreased from 4.55 ± 1.34 to 2.65 ± 0.8 in ACCF group, from 4.25 ± 0.75 to 2.43 ± 1.40 in laminoplasty group & from 5.04 ± 1.10 to 3.13 ± 0.94 in laminectomy group. Mean JOA score improved from 8.45± 1.14 to 13.7 ± 1.22 in ACCF group, 8.64 ± 1.03 to 14.68 ± 1.65 in laminoplasty group & from 8.86 ± 1.17 to 13.96 ± 1.26 in laminectomy group, with average recovery rate of 64.3 %. Per-operatively 3 patients developed dural tear. Post-operative paresthesia developed in 4 patients, which eventually recovered.

Conclusion: One or two level OPLL can be resected by an anterior approach with corpectomy, whereas expansive laminoplasty or laminectomy is indicated for multilevel compressive myelopathy due to OPLL.