The anterior decompression technique, including vertebral body sliding osteotomy1 and anterior controllable antedisplacement fusion (ACAF),2 treats ossified posterior longitudinal ligament (OPLL) without actual excision of the OPLL.3 The fundamental strategy is to separate the mid-portion of the vertebral body along with the OPLL using bilateral anterior osteotomies followed by controllable antedisplacement. These techniques restore the space of the spinal canal anteriorly by anterior translation of the OPLL, avoiding excision and dural manipulation.4 We illustrate the case of a patient who had failed laminoplasty and the surgical decision making for ACAF. We discuss the other surgical options regarding patient selection, present preoperative and postoperative imaging, to demonstrate the efficacy of ACAF and show strategies of ACAF to make it a safe and effective procedure. We demonstrate our technique of ACAF using the intraoperative microscope and models in this video to illustrate the steps of ACAF. A written consent to the procedure was obtained from the patient.