Abstract: Objective To evaluate the clinical effect of different surgical approaches for treating cervical ossification of the
posterior longitudinal ligament (OPLL) with spinal cord signal change. Methods Thirty-eight patients with OPLL with spinal
cord signal change were treated from January 2005 to January 2011. Surgical removal via an anterior approach or partial
decompression was performed in 10 cases (group A), posterior approach open-door laminoplasty with decompression, bone
grafting and internal fixation was performed in 12 cases (group B), and opening the cervical spinal meninges to relieve the
pressure was performed in 16 cases (group C) on the basis of the procedures in group B. All the patients were followed up and
the pre- and postoperative JOA scores, improvement ratio and inter-body implant fusion were evaluated. Imaging
examinations including X-rays, CT and MRI were also performed pre- and postoperatively, and the surgical complications
were recorded. Results At 12 months postoperatively, the mean improvement rates in groups A, B, and C were 52.39%,
55.15%, and 60.32%, respectively, with the mean JOA scores of 13.54±0.56, 13.56±1.26, and 14.70±1.41, respectively. The JOA
scores and improvement rates significantly increased after the surgeries. One patient in group A became paraplegic after the
operation with cerebrospinal fluid leakage, and one patient in group B and one in group C reported numbness of the upper
limb. Group C showed a shorter postoperative recovery time without severe complications. Conclusion Posterior open-door
laminoplasty, decompression, bone grafting and internal fixation can be an effective approach for treatment of cervical OPLL
with spinal cord signal change and requires shorter rehabilitation time after the operation.