Should I choose anterior or posterior surgery for cervical spondylosis? One center, two basic points! The patient’s condition is the center of the decision, taking into account the two basic points of benefit and risk. Indications for anterior surgery: compression from discs in front of the spinal nerve, bone spur compression, relatively limited, not many segments (no more than three disc ranges). Microscopic: anterior cervical discectomy, decompression and bone grafting fusion or anterior vertebral body excision, decompression and bone grafting fusion can be chosen. Advantages: 1, less bleeding, less trauma (transgap like road), quick recovery (day surgery) 2, good maintenance of intervertebral height, can better restore the normal physiological curvature of the cervical spine 3, high fusion rate of intervertebral implants Disadvantages: not suitable for multi-segment, severe spinal cord compression. The risk is higher than that of the posterior approach. Indications for posterior surgery: applicable to multi-segmental cervical spondylosis (more than three discs), with cervical spinal stenosis or continuous type of posterior longitudinal ligament ossification. Optional microscopic: posterior single-opening spinal canal enlargementplasty. Advantages: indirect decompression is achieved by decompressing and reconstructing the posterior cervical spine lamina. The surgical risk is less than that of the anterior approach and the efficacy is definite. Disadvantages: Not suitable for patients with posterior cervical deformity. Combined anterior and posterior surgery: If the patient’s spinal cord compression is severe both anteriorly and posteriorly, then the surgeon has to choose combined anterior and posterior surgery. Generally, the posterior approach is done in the prone position, such as a single posterior cervical canal enlargement, and then the patient is turned over in the supine position for decompression and fixation from the anterior approach. Of course, this is not rare. In conclusion, the key to cervical spine surgery is the direction of compression of the spinal cord and the number of compressed segments, as well as the cervical spine curvature to make a suitable choice for the patient.