Background: Cervical spondylotic myelopathy (CSM) is a malfunction of the spinal cord caused by spinal canal constriction. Spondylosis, congenital stenosis and disc herniation are frequent causes, often occurring in conjunction. The study aimed to compare radiological and clinical results following multiple level ACDF versus posterior cervical decompression for degenerative cervical myelopathy treatment. Methods: This study was conducted on 40 participants suffering degenerative CSM because of multi-level cervical spondyolosis and subjected to surgical treatment. 20 patients with multiple ACDF as A group and 20 participants suffering posterior cervical decompression as B Group. Clinical and radiological outcomes of both groups were compared together. Results: The difference between Group A and Group B was not statistically critical concerning improvement of both post-operative mJOA scale and myelopathy scale as the median of preop (mJOA) was 12 (9-13) while post-operative (mJOA) scale was 16 (14-17) among Group A and was 8 (6-9) preoperatively then became 13.5 (12.25-14.75) postoperatively among Group B. The difference between anterior and posterior approach groups was statistically critical regarding post-operative cervical lordosis angle (P