Ossification of the Posterior Longitudinal Ligament (OPLL) is a condition characterized by pathologic replacement of the posterior longitudinal ligament (PLL) with lamellar bone. It is classically associated with cervical myelopathy in the East Asian population, cited at a relatively higher incidence than among Europeans. OPLL is thought to be initiated by vascular infiltration, hypertrophy, and eventual endochondral ossification of the PLL. Genetic links and medical comorbidities have been implicated as risk factors for development of OPLL, and include hyperparathyroidism, hypophosphatemic rickets, hyperinsulinemia (even in the absence of clinical diabetes), and obesity. Males are additionally affected twice as often as females. BMI and hyperinsulinemia have further both been shown to correlate directly not only with the development but with the extent of the disease. Surgical decompression is indicated with progressive or severe neurologic symptoms.