Is Surgery Always Necessary for OPLL?

by Son PMR(Physical medicine & Rehabilitation ) & Chiropractic Clinic in Seoul




Among the many ligaments that support the spine, the posterior longitudinal ligament (PLL) plays a key role in protecting the spinal cord, as it runs along the back side of the vertebral bodies inside the spinal canal. However, in some cases, this ligament can become hardened and turn into bone-like tissue—a condition known as ossification of the posterior longitudinal ligament (OPLL).

OPLL most commonly affects the cervical spine (neck area) and may gradually compress the spinal cord, leading to various neurological symptoms.

What Are the Symptoms of OPLL?

OPLL often develops slowly and may go unnoticed in the early stages. Over time, however, symptoms can include:

  • Tingling or numbness in the hands

  • Difficulty with fine motor skills (e.g., buttoning a shirt)

  • Weakness in the arms or legs, unstable walking

  • In more severe cases, bladder or bowel dysfunction

[Reference 1]
Matsunaga S. et al. (2004). “Surgical outcomes of ossification of the posterior longitudinal ligament in the cervical spine: a long-term follow-up study.” J Bone Joint Surg Am.
→ This study showed that over half of OPLL patients have mild symptoms initially, and many can be managed without surgery.

Is Surgery Always Required?

Not every case of OPLL requires surgery. Conservative (non-surgical) treatment may be suitable in the following cases:

  • Mild or no symptoms

  • No significant spinal cord compression on imaging

  • Ability to perform daily activities without major difficulty

Surgery is typically considered in the following situations:

  • Rapidly worsening neurological symptoms

  • Gait disturbance or paralysis

  • Persistent pain or dysfunction unresponsive to conservative care

[Reference 2]
Kawaguchi Y. et al. (2019). “Classification and management of cervical ossification of the posterior longitudinal ligament: Recommendations of the 2019 OPLL Consensus Group.” Spine.
→ This guideline highlights the importance of individualized treatment depending on the severity of spinal cord compression and symptom progression.

Upper Cervical Correction – A Non-Surgical Approach

OPLL is not only a structural issue—it is also closely linked with alignment abnormalities in the upper cervical spine (C1 and C2). Misalignment in this area can subtly affect spinal cord tension and brainstem function.

At Son Chul Ho Rehabilitation Medicine Clinic, we offer a personalized, non-surgical approach using precise upper cervical correction for selected patients whose symptoms are not severe.

This approach includes:

  • CBCT imaging to evaluate detailed cervical spine alignment

  • Functional tests such as prone leg check and head rotation response

  • Gentle, specific adjustments tailored to the patient’s unique structure

The goal is to relieve stress on the nervous system, promote natural balance, and improve neurological function without invasive procedures.

[Reference 3]
Hsu WL et al. (2016). “Relationship of cervical spine alignment to ossification of the posterior longitudinal ligament and clinical symptoms.” J Neurosurg Spine.
→ This study suggests a correlation between cervical alignment and OPLL, supporting the potential benefit of non-surgical structural correction.

Final Thoughts

OPLL is a condition that may slowly progress and eventually affect quality of life. While surgery is necessary in some cases, many patients can be managed through accurate diagnosis, close monitoring, and personalized, non-invasive care such as upper cervical correction.

At Son Rehabilitation Medicine & Chiropractic Clinic, we strive to provide care that respects both the structure of the body and the quality of each patient’s life. With gentle hands and a careful heart, we are here to walk this path with you.

References

  1. Matsunaga S, et al. J Bone Joint Surg Am, 2004.

  2. Kawaguchi Y, et al. Spine, 2019; OPLL Consensus Group.

  3. Hsu WL, et al. J Neurosurg Spine, 2016.

👍Consultation and Appointment Information

Son PMR & Chiropractic Clinic( 2nd floor, 229-1 Gucheonmyun-Ro, Gangdongu, Seoul, South Korea) 

by  Dr Son MD & DC 
Contact: 02-482-8875 in Seoul( +82-2-482-8875)

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