Background: The ossification of the posterior cervical longitudinal ligament (OPLL) is one of the main causes of cervical spondylitis myelopathy (CSM). Apart from conservative approaches, both anterior and posterior surgeries have been introduced into clinical practices for managing OPLL patients. Methods: Electronic databases including PubMed, Embase and CNKI were searched to retrieve eligible publication sir respective of language restrictions. Only studies compared the efficacy and safety between anterior and posterior surgery were included. All extracted data were expressed as standard mean difference (SMD) with 95% confidential interval (95% CI) in the forest plot. In addition, heterogeneity among studies was assessed through the I2 and P-value as well. Finally, publication bias was evaluate dusing the comparison-adjusted funnel plot. Results: A total of 33 studies with 2,910 subjects were contained in this meta-analysis. The pooled SMD of post-operative JOA score was 0.70 with 95% CI from 0.39 to 1.00, suggesting significant difference between these two surgical strategies. The merged SMD of IR was 0.48 with 95% CI from 0.25 to 0.72, which confirmed the same results gained from JOA score. The pooled SMD for operation time was 0.84 with a 95% CI from 0.25 to 1.42. No publication bias was found for each outcome. Conclusions: The anterior approach had relatively better performance with respect to efficacy in managing OPLL or CSM. Since there was no significant difference in blood loss or complications between the anterior and posterior surgery, safety between these two approaches may be similar. As suggested by a shorter operation time, the posterior surgery seemed to be better than anterior surgery. Therefore, OPLL patients managed by the anterior surgery may benefit from its relatively strong effectiveness, while posterior surgery is comparatively safe for OPLL patients. More studies should be carried out to confirm the above conclusions.