Anterior Versus Posterior Surgical Approaches in Degenerative Cervical Myelopathy: A Single-Center Retrospective Comparative Study of 102 Patients

Background/Objectives: Degenerative cervical myelopathy (DCM) is the leading cause of non-traumatic spinal cord dysfunction in adults. Both anterior and posterior surgical approaches are widely used for its treatment, yet their comparative impact on clinical outcomes and complication profiles remains clinically relevant. This study aimed to describe early and one-year postoperative outcomes between anterior and posterior surgical strategies in a consecutive single-center cohort. Methods: We conducted a retrospective single-center study of 102 consecutive adult patients surgically treated for DCM between 2013 and 2024, with complete datasets and a minimum one-year follow-up. Surgical approaches were classified as anterior, posterior, or combined. Clinical outcomes were assessed using the modified Japanese Orthopaedic Association scale (mJOA), Neck Disability Index (NDI), and Numeric Rating Scale for arm pain (NRS-arm) preoperatively, at 4–6 weeks and at one year. Complications were systematically recorded and stratified by approach. Nonparametric tests were used for all comparisons (significance threshold p < 0.05). Results: Anterior procedures were performed in 82 patients (80.4%), posterior in 18 (17.6%), and combined in 2 (2.0%). No significant between-group differences were observed in neurological, functional, or pain outcomes at either time point (ΔmJOA p = 0.268; ΔNDI p = 0.632; ΔNRS p = 0.562 at one year). Complications occurred in 13 patients (12.7%), with approach-specific profiles: anterior surgery was associated with hematoma, dysphagia, and dysphonia, posterior surgery with CSF leak, wound infection, and kyphosis. No C5 palsy was recorded. Conclusions: Both anterior and posterior surgical approaches were followed by neurological and functional improvement at one year. Given the descriptive nature of the study and the baseline differences between groups, these findings should not be read as a formal comparison of effectiveness, but they reinforce the importance of individualized, pathology-driven surgical planning in DCM.