Abstract: [Objective] To compare and analyze the clinical efficacy of posterior longitudinal ligament resection versus preservation during anterior cervical corpectomy and fusion (ACCF). [Methods] This paper retrospectively studied the data of 81 patients who underwent single vertebral ACCF in our hospital from March 2017 to March 2022. 38 patients had preserved the posterior longitudinal ligament (preservation group) and 43 patients had resected the posterior longitudinal ligament (resection group), and patients’ data of pre-treatment, follow-up and imaging were analyzed. [Results] All patients’ surgeries were successful. The two groups’ differences in the number of fluoroscopy, total incision length, walking time, incision healing grade and the number of days in hospital were not significant (P>0.05). Compared to the preservation group, the resection group’s early complication rate, duration of surgery and amount of blood loss were markedly higher (P<0.05). Follow-up was more than 12 months, the two groups’ differences in the recovery time of full weight-bearing activities were not significant (P>0.05). With the progression of time, the two groups’ NDI score, JOA score and pyramidal tract sign were markedly improved (P<0.05). At the corresponding time points, the JOA score of the resection group was markedly bigger than that of the preservation group (P<0.05), but the differences in NDI score and pyramidal tract sign between the two groups were not significant (P>0.05). In terms of imaging, Both groups’ cervical lordosis angle and cervical ROM were significantly improved (P<0.05), while their differences in the above indicators were not significant (P>0.05). Postoperative minimum spinal canal sagittal diameter was markedly increased in both groups, and was more obviously increased in resection group (P<0.05). [Conclusion] When performing single vertebral ACCF, the posterior longitudinal ligament can be removed in some cases after careful evaluation of preoperative imaging data and intraoperative conditions, but complications should be noted.