Abstract: [Objective] To compare the efficacy of one-stage anterior and single-stage posterior surgery for the treatment of ossification of the posterior longitudinal ligament with developmental cervical stenosis. [Methods] A retrospective analysis of 31 patients with ossification of the posterior longitudinal ligament of the cervical spine with vertebral stenosis in our hospital from April 2013 to July 2016, 16 patients underwent one-stage anterior-posterior surgery as AP group，15 patients were treated by single-stage posterior surgery as P group. The Japanese Orthopaedic Association (JOA) scores were used to evaluate the clinical consequences. X-ray, CT and MRI were performed preoperative and postoperative. Pavlov ratio, spinal cord reserving space, and K-line(+)% were used to evaluate the effect of surgical decompression. The preoperative and postoperative JOA scores, the improvement rate of JOA scores, and the complications of the two groups were recorded. [Results] All 31 patients were followed up. All patients had no internal fixation loosening, fusion failure, and implant fracture. There were no significant differences in preoperative JOA score, Pavlov ratio, spinal cord reserving space, K-line (+)%, and postoperative Pavlov ratio between the two groups (P>0.05). JOA score, postoperative and last postoperative and postoperative follow-up JOA improvement rate in the AP group was higher than that in the P group. The difference between the two groups was statistically significant (P<0.05). The K-line(+)% at the last follow-up and the AP group in the spinal cord buffer space were significantly higher than those in the P group. The difference was statistically significant (P<0.05). There was no significant difference in postoperative complications between the two groups (P>0.05).[Conclusion] One-stage anterior-posterior surgery is more safe, reasonable and effective than single-stage posterior approach for the treatment of cervical posterior longitudinal ligament ossification with developmental spinal canal to obtain greater decompression and improve clinical efficacy.