• Xiaofei Sun, Fudong Li, Baolian Zhao, Bin Zhang, Kaiqiang Sun, Jingchuan Sun, Ximing Xu, Yuan Wang, and Jiangang Shi.
• Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China.
• Spine. 2024 Feb 15; 49 (4): 239246239-246.

Study DesignA clinical classification of cervical ossification of the posterior longitudinal ligament (COPLL) was developed based on imaging findings.ObjectiveThis study aimed to establish a clinical classification for COPLL and provide corresponding surgery strategies for each subtype.Summary Of Background DataA practical and reliable classification is needed to guide the treatment of COPLL.Materials And MethodsThis study retrospectively reviewed plain radiographs, computed tomography scans, and magnetic resonance images of patients diagnosed with COPLL between 2018 and 2022 at Shanghai Changzheng Hospital. The types of COPLL were classified according to the location, morphology, and canal-occupying ratio (OR) of the ossification mass. Interobserver and intraobserver reliability were evaluated using Cohen's kappa.ResultsA total of 1000 cases were included, which were classified into five types: focal type (F type), short-sequential type (S type), long-sequential type (L type), high type (H type), and mixed type (M type). In addition, each type could be classified into subtype 1 or subtype 2 according to the canal-OR. Then each type could be further classified into other subtypes according to location and morphology. The interobserver reliabilities in the first and second rounds were 0.853 and 0.887, respectively. The intraobserver reliability was 0.888.ConclusionThe authors classified COPLL into a system comprised of five types and several subtypes according to canal-OR, location, and morphology. Surgical strategies for each subtype are also suggested. This provides a theoretical guide for the description and surgical management of COPLL.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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