The most common and neurologically important enthesopathy that is caused by inflammation of tendinous and ligamentous attatchments to bone is ossification of posterior longitudinal ligament (OPLL). The OPLL can occur at the posterior surface of the spinal vertebral bodies from the foramen magnum to the sacrum; however, the cervical portion of the vertebra is mainly affected. The cervical OPLL is originally thought to occur only in individuals of Japanese descent; however the advances in its diagnosis by using computed tomography and magnetic resonance imaging have led to more frequent identification of the disease in other Asians and whites as well. The cervical OPLL is a surgically treatable cause of myelopathy and various surgical approaches including anterior and posterior approach have been introduced. Although the indications of surgical treatment have been defined, the selection of the most effective operation remains controversial.