Spine Surgery Contemporary VOLUME 17 ■ NUMBER 8 ■ AUGUST 2016 available in the literature, it is estimated that 1.6 of every 100,000 individuals are surgically treated for this condition. 4 This statistic suggests that the number of indi- viduals who experience CSM is much higher. Preferred initial treatment for CSM includes nonoperative modalities such as physical therapy; anti-inflammatory medi- cations; and in some cases, a cervical col- lar. However, refractory cases may require surgical intervention. Current literature has demonstrated surgical decompression of the cervical spine to improve functional outcomes in patients with CSM. 5,6 Decompression can be achieved via an ante- rior or a posterior approach; each method of decompression has its own advantages and disadvantages. To our knowledge, there are no published randomized controlled clinical studies that compare the two approaches directly, which prevents clear conclusions from being drawn. Therefore, this review aims to summarize the current literature regarding anterior and posterior approaches for the treatment of CSM, with specific emphasis on comparing treatment safety and efficacy. ANTERIOR APPROACH TECHNIQUES The anterior approach to the subaxial cervical spine for cervical spondylosis is anterior and posterior techniques for the treatment of cervical spondylotic myelopathy. Key Words: Anterior approach, Cervical spondylotic myelopathy, Posterior approach D egenerative disc disease of the cervi- cal spine is a common phenomenon associated with aging. It begins with a tear in the intervertebral disc. Subsequent degeneration results in the eventual loss of disc height altering the stability and struc- ture of the vertebral level. These common structural changes may result in spinal canal narrowing and pathologic changes at adjacent levels. Although degenerative disc disease is often asymptomatic, significant compression of the spinal cord may lead to symptomatic cervical spondylotic myelopa- thy (CSM), 1 commonly presenting as loss of fine motor control, incontinence, spasticity, and gait imbalance. Given the degenerative nature of the pathologic process, CSM is frequently observed in older adults, is reported to be the most common cause of myelopathy in patients older than 55 years, 2 and is the most common cause of spinal cord dysfunc- tion in the world. 3 Although the precise incidence and prevalence of CSM are not LEARNING OBJECTIVES: After participating in this CME activity, the spine surgeon should be better able to: 1. Describe the advantages and disadvan- tages associated with anterior and poste- rior approaches for treatment of cervical spondylotic myelopathy. 2. Evaluate clinical evidence concerning Mr. Massel and Mr. Mayo are Research Coordinators, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois; Dr. Puvanesarajah is Resident, Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland; Dr. Hassanzadeh is Assistant Professor, Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia; Dr. Presciutti is Assistant Professor, Department of Orthopaedics, Emory University, Atlanta, Georgia; and Dr. Phillips is Professor, Department of Orthopaedic Surgery, Rush University Medical Center, 611 W Harrison St, Ste 300, Chicago, IL 60612; E-mail: frank.phillips@rushortho.com. All faculty and staff in a position to control the content of this CME activity, and their spouses/life partners (if any), have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations related to this CME activity. Lippincott Continuing Medical Education Institute is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on July 31, 2017. Surgical Decision Making in Cervical Spondylotic Myelopathy: Comparison of Anterior and Posterior Approach Dustin H. Massel, BS, Varun Puvanesarajah, MD, Benjamin C. Mayo, BA, Hamid Hassanzadeh, MD, Steven M. Presciutti, MD, and Frank M. Phillips, MD