We retrospectively studied patients with cervical myelopathy due to OPLL to compare surgical outcome of anterior approach with that of laminoplasty. In patients with occupying ratio > or = 60%, the anterior approach yielded a better neurological outcome than laminoplasty. Although the anterior approach is technically demanding and has a higher incidence of surgery-related complications, it is preferable to laminoplasty for patients with occupying ratio of OPLL > or = 60%and/or hill-shaped ossification.