The posterior longitudinal ligament of the cervical spine is a ligament located posterior to the vertebral body within the cervical spinal canal. The posterior longitudinal ligament is often heterotopic due to a number of factors, resulting in compression of the cervical medulla and nerve roots, resulting in clinical symptoms of spinal cord injury and nerve root irritation, called cervical posterior longitudinal ligament ossification. Osteosynthesis of the posterior longitudinal ligament of the cervical spine has an insidious onset, and in the early stage, because the cervical marrow gradually adapts and compensates in the process of chronic compression, there are often no symptoms of spinal cord compression in the early stage, and often the imaging manifestations are already very serious when the patients have obvious clinical symptoms, and some patients are even discovered only when they develop cervical hyperextension injury or even irreversible complete paralysis after minor trauma. Posterior longitudinal ligament ossification of the cervical spine requires surgical treatment, and there are no drugs available to control the progression of posterior longitudinal ligament ossification. The surgical approach is divided into anterior cervical surgery, posterior cervical surgery, and combined anterior and posterior approaches. Clinically, for patients with isolated posterior longitudinal ligament ossification of the cervical spine, anterior decompression surgery is an option. Since the compression is mainly from the anterior aspect of the spinal cord, anterior surgery is the most direct and effective way to decompress the ossification directly. Anterior surgery can not only completely remove the ossified ligament, but also reconstruct the physiological curvature of the cervical spine, and also improve the blood supply to the spinal cord and promote the recovery of neurological function. For continuous or mixed posterior longitudinal ligament ossification in more than 3 segments. This is often treated clinically by a posterior cervical single- or double-opening vertebroplasty (Arch plate) and total laminectomy. The clinical decision to perform a canalplasty or total laminectomy is made by measuring whether the midpoint line between C2 and C7 on a lateral cervical spine radiograph crosses the ossification. The combination of Arch plate screw vertebroplasty is effective in preventing reclosure and reducing symptoms of axial pain and C5 nerve root palsy and maintaining cervical mobility (ROM), but the results of spinal cord function restoration are not as good as total laminectomy decompression. However, in clinical practice, for patients with continuous cervical posterior longitudinal ligament ossification, simple posterior decompression cannot remove the ossification because it is an indirect decompression, and patients will more or less complain about some residual symptoms after surgery; after all, the anterior compression-causing material is still present. Then, for this type of patients, I tend to adopt a combined anterior-posterior approach for decompression at the risk of higher surgical risk: first perform posterior hemivertebral decompression to give the spinal cord a space for posterior displacement, close the incision, and then perform anterior cervical decompression to remove the ossified material of the posterior longitudinal ligament after turning, so as to completely release the compression from the anterior part of the spinal cord. Because of the high rate of stenosis after compression, the surgical risk is very high, but I think it is worthwhile for the surgeon to take such a risk in order to obtain an adequate and effective decompression. In a combined anterior-posterior approach, we also need to prepare a miniature grinding turn, which is a necessary instrument. The grinding drill allows for thinning of the ossified posterior longitudinal ligament with minimal spinal cord disturbance. In addition, the incidence of cerebrospinal fluid leakage after anterior removal of ossified posterior longitudinal ligaments in patients with cervical ossification is very high, so the management of cerebrospinal fluid leakage is a very critical component of postoperative management. Before we do this procedure, we approach it according to the thinking that cerebrospinal fluid leakage occurs postoperatively. Whether or not there is a cerebrospinal fluid leak intraoperatively, we close the incision by placing a fine drainage tube with normal pressure drainage and alternating layers of tight sutures, leaving no dead space. If a postoperative cerebrospinal fluid leak occurs, the drainage tube is removed after the wound has healed for 5 days postoperatively, and a cervical sandbag is placed to compress the wound for 24 hours at the same time. Very few patients may also require lumbar pool drainage to reduce pressure and promote fistula closure.