Postoperative Progression of Cervical Ossification of the Posterior Longitudinal Ligament: A Narrative Review Comparing Posterior Decompression with Fixation and Posterior Decompression Alone

This narrative review compares decompression alone and decompression with fixation in the surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL) in terms of postoperative progression of ossification. Using published studies, we analyzed ossification size changes at the surgical site and adjacent segments. The results suggest that fixation not only stabilizes the spine but may also suppress the progression of ossification, although neurological outcomes were comparable between decompression with fixation and decompression alone. However, the enlargement of ossification observed at the segments adjacent to the operated levels is occasionally greater in cases treated with decompression with fixation than in those treated with decompression alone. These results may be important in determining the optimal surgical strategy based on OPLL morphology and spinal alignment.