This paper reviews 88 patients (74 males and 14 females) who underwent anterior decompression and fusion for symptomatic ossified posterior longitudinal ligament of the cervical spine. Follow up averaged 8.5 years. Eighteen patients underwent one-vertebra, 59 two-vertebra, and 11 three-vertebra decompression with interbody fusion. The preoperative severity of symptoms significantly affected neurological recovery. Patients with three-vertebra spondylectomy showed significantly little neurological improvement. The return of patients to their previous activities as monitored at follow up was related to their preoperative neurological status. MRI findings appeared to be relevant to neurological recovery. Our findings suggest that anterior decompression is to be recommended for patients with less advanced preoperative symptoms and the involvement of one or two vertebrae.