In our study, overexpression of miR-140-5p exosomes reversed the promotion in osteogenesis caused by the upregulation of IGF1R and inhibited the osteogenic differentiation of hMSCs, suggesting that drugs targeting IGF1R on the surface of MSCs in the posterior longitudinal ligament (such as exosomes delivering miR-140-5p) may serve as a therapy for OPLL in the future. This evidence concerns the gene IGF1R and ossification of the posterior longitudinal ligament of the spine.