Anterior vs. posterior approaches in the management of multilevel degenerative cervical myelopathy: a systematic review and meta-analysis

Both surgical approaches yield comparable long-term outcomes, with anterior surgery demonstrating statistically significant early functional advantages, shorter LOS, and lower odds of C5 palsy. However, these advantages diminish over time, with functional improvements not consistently reaching MCIDs. Given the heterogeneity of DCM, surgical decision-making should be individualized, incorporating patient-specific factors and long-term functional priorities to optimize outcomes.