Study Design. Systematic Review Objectives. Systematic review was performed to determine the more superior approach in treating patients diagnosed with Moderate- Severe (based on the Japanese Orthopedic Association and modified Japanese Orthopedic Association scores) types of Multilevel Cervical Spondylotic Myelopathy (CSM) involving three (3) or more levels.

Summary of Background Data. Cervical myelopathy (CM) is defined as a clinical disease involving loss of fine motor control and coordination, gait dysfunction with long tract signs, and imaging evidence of Cervical cord compression. Degenerative cervical myelopathy (DCM) is defined as a symptomatic myelopathy caused by degenerative changes to the spinal axis. These include, but are not limited to, osteoarthritic changes, facet arthropathy, hypertrophy, ossification of the posterior longitudinal ligament or ligamentum flavum. Cervical spondylotic myelopathy (CSM), which was the main focus of this study, is defined as myelopathy secondary to spondylotic changes or disc degeneration. There has been no consensus on the more superior approach (Anterior or Posterior) and which approach has the higher complication rate.

Methods. A systematic review was conducted comparing both approaches in terms of the post- op recovery for at least one year and the complication rates for each. Standard mean differences were obtained for the improvement of the JOA/mJOA scores while the number of complications in comparison to the number of surgeries done/ participants was also analyzed.

Results. Eight (8) studies were included: One (1) Randomized Controlled Trial, one Non- Randomized Controlled Trial, One prospective Cohort, and four (4) Retrospective Cohort studies. All of which provided non- significant results in terms of the JOA/mJOA scores for a minimum of 1 year. While for the complication rate, no significant findings could be obtained in terms of the complication rate (Medical, Intraoperative, Post-Operative) but the posterior approach has a significantly higher complication rate (95% Confidence Interval) excluding the medical and intraoperative complications.

Conclusion. The systematic review demonstrates that neither approach is more effective in terms of the recovery rate via the JOA/mJOA scores for a minimum of one (1) year but the surgical complication rate is significantly higher for the posterior approach.