The posterior longitudinal ligament lines the anterior wall of the spinal canal, wider at disc levels where it provides central resistance to disc herniation. Ossification of the PLL (OPLL) — particularly common in East Asian populations — produces progressive cervical canal stenosis and myelopathy from calcified ligament encroachment on the cord.
| Origin | Posterior aspect of vertebral bodies from C2 to the sacrum (wider at disc levels, narrow at vertebral bodies) |
|---|---|
| Insertion | Continuous along the posterior vertebral column inside the spinal canal |
| Actions | Resists flexion; limits posterior disc herniation centrally; the ossification of the PLL produces the most common cause of cervical myelopathy in Asian populations |
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OPLL affects up to 3% of East Asian adults and is classified by morphology (segmental, continuous, mixed, circumscribed). Surgical treatment — laminoplasty or corpectomy depending on pattern — decompresses the cord. The PLL must be excised in anterior cervical corpectomy for adequate decompression.
Progressive PLL calcification producing cervical myelopathy managed with laminoplasty or anterior corpectomy decompression.
