Abstract Background: Anterior controllable antedisplacement and fusion (ACAF) is a new surgical technique for treating ossification of the posterior longitudinal ligament (OPLL). Although ACAF has been widely used, its related decompression prognostic factors have not been fully studied. Objective:To compare the clinical outcomes and postoperative complications of ACAF and laminoplasty (LP) in the treatment of OPLL, and to evaluate the advantages and disadvantages of both surgical methods. Methods: Randomized or non-randomized controlled trials comparing ACAF with LP were searched in PubMed, Embase, Cochrane Library, Science Direct, CNKI databases and reference lists. Relevant outcome indicators were extracted from these studies for data analysis using STATA 17 software. Results: After surgery, ACAF was superior to LP in terms of postoperative Japanese Orthopaedic Association Score [WMD=0.906, 95%CI (0.374, 1.438), P=0.001<0.05] and Japanese Orthopaedic Association Score improvement rate [WMD=8.903, 95%CI(5.964,11.841), P< 0.05]. LP was superior to ACAF in terms of postoperative visual analogue scale [WMD=-0.809, 95%CI(-1.132,-0.487), P<0.05].postoperative cervical spine activity [WMD=-3.225, 95%CI(-5.829,-0.681), P=0.013< 0.05], and postoperative cervical curvature [WMD=7.826, 95%CI(6.505,9.147), P<0.05].ACAF was superior to LP in terms of C5 nerve root paralysis [OR=0.236, 95%CI (0.082,0.678), P=0.007<0.05] and postoperative medulla oblongata symptoms [OR=0.181, 95%CI (0.066,0.497), P=0.001<0.05]. ACAF had a higher incidence of postoperative dysphagia than LP [OR=9.614, 95%CI (2.168,42.629), P=0.003<0.05], and the postoperative overall complication rate of ACAF was lower than that of LP [OR=0.606, 95%CI (0.373,0.983), P=0.043<0.05]. Conclusion: Both ACAF and LP can achieve good clinical results in the treatment of OPLL, but ACAF has better neurological function recovery after surgery and a lower incidence of axial symptoms,C5 nerve root paralysis,and total complications after surgery compared to LP.