Neurogenic cervical spondylosis is the most common type of cervical spondylosis, and its etiology can be caused by extrusion of bone, acute trauma, chronic strain, small joint misalignment after joint capsule relaxation, and vertebral heterotaxy. Bony and soft tissue factors cause narrowing of the intervertebral foramen, edema, inflammation, and adhesions of the nerve roots under pressure. Surgery can be considered for patients who have been ineffective with regular non-surgical therapy for more than 3 months, or for patients whose work, study and life are affected by recurrent symptoms despite the effectiveness of non-surgical therapy. Anterior cervical decompression and fusion surgery (ACDF) is currently one of the major procedures for the treatment of neurogenic cervical spondylosis. Since it was first reported by Smith and Robinson in the 1950s, ACDF has evolved over the past half century and is considered the “gold standard” for the treatment of neurogenic cervical spondylosis. However, this “gold standard” still lacks strong direct evidence support because previous studies either lacked a non-surgical control group or were non-prospective randomized controlled studies with a low level of evidence. For this reason, Swedish academic Markus Engquist et al. conducted a prospective randomized controlled study comparing the efficacy of ACDF plus physiotherapy with physiotherapy alone for the treatment of neurogenic cervical spondylosis. In this study, 63 patients with neurogenic cervical spondylosis were randomly divided into two groups: one group received ACDF followed by physiotherapy, called the surgical group, and the other group was treated with physiotherapy alone without surgery, called the non-surgical group. A total of 31 patients were randomly assigned to the surgical group compared to 32 patients in the non-surgical group. The physical therapy consisted of general and specific functional exercises, as well as treatments related to pain relief. Patients were followed up for more than 24 months, and the main evaluation indicators included the Neck Dysfunction Index (NDI), VAS scores for neck and arm pain intensity, and an assessment of the patient’s overall condition. The results of this study showed that NDI scores and VAS scores for neck and arm pain were significantly lower in both groups after treatment compared to baseline. Repeated measures ANOVA showed no statistically significant differences in NDI scores, VAS scores for arm pain between the two groups, but patients in the surgical group had significantly smaller VAS scores for neck pain than patients in the non-surgical group. At the 12th month of postoperative follow-up, 87% of patients in the surgical group rated their symptoms as better/significantly better than before surgery, compared with 62% of patients in the non-surgical group, with a significant difference between the two groups. By the 24th month of postoperative follow-up, 81% of patients in the surgical group and 69% of patients in the non-surgical group rated their symptoms as better/significantly better than before surgery, and there was no significant difference between the two groups.