Background: Anterior and posterior cervical decompression approaches are utilized in cases of cervical spondylotic myelopathy (CSM). The choice of approach depends on patient-specific factors like spinal alignment and comorbidities. The current study aimed to compare the clinical outcomes of anterior and posterior cervical decompression for the treatment of CSM. Methods: A total of 35 cases were included in the study. 15 underwent anterior decompression with corpectomy followed by placement of an expandable titanium cage to reconstruct the anterior column with the addition of an anterior cervical plate. 16 patients underwent a posterior decompression with laminectomy followed by posterior instrumentation with lateral mass screws and 4 patients with laminoplasty. Results: Clinical evaluation revealed significant improvement in both groups following spinal cord decompression according to scores on the mJOA scale and Nurick (p < 0.05). The comparison between the anterior and posterior groups shows a statistical difference for the posterior approach. After the operations, according to the Nurick and mJOA scale score (p < 0.05) No complications, and deep venous were recorded in the cases. Conclusion: The study examined the surgical treatment of degenerative cervical spinal canal stenosis with anterior and posterior approaches. We found significant changes in mJOA and Nurick grades in pre and post-surgeries in both groups. Posterior decompression surgery produced superior gains in mJOA scores. The anterior approach was found to have reduced hospital stay. Both procedures led to zero complications.