Ossification of the posterior longitudinal ligament is bone formation within the ligament behind the vertebral bodies, inside the spinal canal. It commonly affects the neck and can narrow the space for the spinal cord, causing myelopathy or remaining clinically silent.
A ligament develops bone
This process creates actual bone within a ligament and differs from a disc herniation. Ossification can involve separate segments or extend continuously across several levels. Its causes are multifactorial. Finding it on a scan does not automatically establish the explanation for neck pain.
Manifestations and warning signs
Clumsy hands, a stiff gait, falls or tingling may indicate cord compression. Severe canal narrowing can increase vulnerability to injury. New weakness or numbness after a fall requires immediate emergency assessment, as does new loss of bladder control. Gradually declining hand or walking function also warrants prompt specialist review.
Tests and differential diagnosis
CT defines the abnormal bone particularly well. MRI evaluates spinal cord compression and changes within the cord. Examination looks for myelopathy and helps distinguish peripheral neuropathy or disc-related compression. Cervical alignment and the number of involved levels influence treatment planning.
Treatment and outlook
Clinical monitoring may be appropriate without significant myelopathy. Symptomatic or progressive cord compression can require surgery; the approach depends on anatomy and carries specific risks. Medication may help associated pain but does not dissolve ossification. Follow-up evaluates function as well as the scans.
Role of TAGMED care
Signs of spinal cord dysfunction require specialist assessment first. Forceful cervical manipulation or traction must not be used in an attempt to remove the bone. Cautious functional support can be considered only after medical risks, activity restrictions and neurological status have been clarified.
Frequently asked questions
Is this ordinary osteoarthritis?
No. Ligament ossification is a distinct abnormality, although the conditions can coexist.
Can MRI identify it?
Yes, but CT provides a clearer assessment of the bone.
Does absence of pain exclude cord involvement?
No. Difficulty walking or fastening buttons may be more informative.
Is surgery always required?
No. Neurological findings and progression guide the decision.
Can exercises remove the ossification?
No. They cannot make the bony mass disappear.
Conceptual diagram: risk depends on compression and neurological status.
Medical references
- Japanese Orthopaedic Association / Japanese Society for Spine Surgery and Related Research. The Essence of Clinical Practice Guidelines for Ossification of Spinal Ligaments, 2019: 3. Diagnosis of OPLL.
- Japanese Orthopaedic Association / Japanese Society for Spine Surgery and Related Research. The Essence of Clinical Practice Guidelines for Ossification of Spinal Ligaments, 2019: 4. Treatment of Cervical OPLL.
- Japanese Orthopaedic Association / Japanese Society for Spine Surgery and Related Research. The Essence of Clinical Practice Guidelines for Ossification of Spinal Ligaments, 2019: 2. Pathology of OPLL.
References document the topic; their inclusion does not imply endorsement of TAGMED services by those organizations.
Educational information from The Spine Page. This entry does not replace an individual assessment. Documentary version: October 12, 2026. Sylvain Desforges, B.Sc., D.O., N.D., osteopath and naturopath.
TAGMED clinic contact details
For non-urgent consultations and information about available services.
Clinique TAGMED — Terrebonne
1150, rue Lévis, Suite 200
Terrebonne (Québec) J6W 5S6
450‑704‑4447
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1140, avenue Beaumont
Mont-Royal (Québec) H3P 3E5
1‑877‑672‑9060