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The purpose of this study was to compare the clinical effect of anterior cervical corpectomy with fusion vs laminoplasty for cervical ossification of the posterior longitudinal ligament. The outcome measures included the Japanese Orthopaedic Association score, neurological recovery rate, and complication rate. Subgroup A represented studies with the mean preoperative canal occupying ratio being less than 50%, whereas subgroup B represented studies with the mean canal occupying ratio being 50% or greater. In subgroup A, no difference was found between the 2 groups in the postoperative Japanese Orthopaedic Association score and neurological recovery rate. In subgroup B, the anterior cervical corpectomy with fusion group had a higher postoperative Japanese Orthopaedic Association score and neurological recovery rate. The authors recommend anterior cervical corpectomy with fusion for cervical ossification of the posterior longitudinal ligament when the canal occupying ratio is 50% or greater, and they prefer laminoplasty when the canal occupying ratio is less than 50%. [Orthopedics. 2019; 42(3):e309-e316.]., (Copyright 2019, SLACK Incorporated.)