Surgical method for cervical myelopathy caused by ossification of posterior longitudinal ligament depends on cervical sagittal alignment and shape of ossification mass. For K-line (-) patients, indirect decompression method such as laminoplasty may not be effective since posterior shift of spinal cord would not occur. Therefore, other surgical method is frequently needed in this patient group. In this article, we would review surgical methods that could be applied for patients with K-line (-) cervical myelopathy caused by ossification of posterior longitudinal ligament.