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Study Design:This study evaluated the effect of different surgical approaches for severe cervical spondylotic myelopathy with more than 3 segmental stenosis of cervical spinal canal.Objective:To compare the curative effect and complications of different decompression operative fashions on the severe cervical spondylotic myelopathy with more than 3 segmental stenosis of cervical spinal canal.To study spinal cord changes after different operation and discuss the different strategy of surgery treatment on these patients.Methods: 167 patients(109 males and 58 females)with severe cervical spondylotic myelopathy.All patients along with more than 3 segmental stenosis of cervical spinal canal.167 patients had the similar clinical symptoms and image features before operation.58 patients had been undergone posterior fusion and lateral mass screw-plate instrument following laminectomy(group A);51 patients undergone posterior fusion and lateral mass screw-plate instrument with hemilaminectomy(group B);58 patients with anterior fusion plating fixed and compression followed by selective hemilaminectomy(group C).RIS(rate of improvement JOA score) were recorded before and after operation in each patient.MRI features were studied.Statistical analysis was made to compare the RIS ,incidence of complication and the diameter of spinal cord in MRI.Results:All the patients were followed-up for 10-39 months, with an average of 21.5 months.The rate of spinal cord function score improvement was 65.54%(group A),64.34(group B) and 69.55%(group C).The score improve rate of each group had no significant difference(P>0.05).Postoperative neck pain and stiffuess, instability, adjacent segment degeneration and related neurological functions changes are the most complications in our cases.The incidence of neck pain and instability of spine in group A is 56.56% and 43.53% respectively, and had significant difference compared to that of other groups(P<0.05).Similar difference showed between group B and C in the neck pain, stiffness and instability (P<0.05).The incidence of adjacent degeneration and related neurological complications had no significant difference among these groups.The diameter of spinal cord from anterior to posterior in the group A patients had significant difference with that of group B and C(P<0.05).Conclusion:There were little difference on the curative effect in our three surgical approach on cervical spondylotic myelopathy.The incidence of postoperative complication and posterior positioning of spinal cord which may affect the long term curative effect should be concerned on the selection of surgical approach.Anterior fusion and decompression followed by selective hemilaminectomy is better choice than other two approaches.