Advanced cervical spondylosis with ossification into the posterior longitudinal ligament and resultant neurologic sequelae.

Advanced cervical spondylosis (ACS) with ossification of the posterior longitudinal ligament (OPLL) may be distinguished from classical OPLL on magnetic resonance- and computed tomography-based studies by the presence within the hypertrophied posterior longitudinal ligament (PLL) of segments of punctate calcification-ossification. Between 1989 and 1993, 50 patients with an early form of classical OPLL, variably associated with ACS, had cervical surgery. Averaging in their mid-40s in age, and exhibiting signs of radiculopathy or myeloradiculopathy, patients were uniformly managed with anterior surgical decompression and fusion. The average follow-up interval was 38 months (range 18-66 months). In select patients, early OPLL coexisted with classic OPLL. ACS with OPLL may represent an early form of the generation of classic OPLL in younger symptomatic individuals, which may be successfully addressed with an anterior surgical approach.