Why I Prefer Anterior Cervical Surgery Over Posterior Approaches

As a spine surgeon with over 30 years of experience and more than 4,000 spine surgeries performed in Dubai, one of the most common questions I get is:

“Why do you prefer the anterior approach to cervical spine surgery over the posterior approach?”

The short answer: Anterior Cervical Surgery — particularly Anterior Cervical Discectomy and Fusion (ACDF) or Artificial Disc Replacement (ADR) — provides more direct access, less muscle disruption, faster recovery, and better long-term outcomes for most cervical spine conditions.
Let me explain why this approach has become my standard for the majority of cervical disc herniation, foraminal stenosis, radiculopathy, and myelopathy cases

Understanding the Surgical Choice

When treating cervical spine problems like:

The choice of surgical approach significantly impacts patient outcomes. Here’s a direct comparison:

Anterior vs. Posterior Cervical Spine Surgery

Factor	Anterior Cervical Approach (ACDF / ADR)	Posterior Cervical Approach
Access to Pathology	Direct access to remove herniated discs and osteophytes	Indirect; must go around the spinal cord
Muscle Disruption	Minimal — dissects through natural tissue planes	Significant — involves muscle stripping
Post-Operative Neck Pain	Typically less	Higher risk of chronic axial neck pain
Restoring Cervical Lordosis	Yes — via cage or artificial disc implantation	Limited or not possible
Ideal for Kyphotic Spine?	Yes	No
Multilevel Decompression	Safe and stable with fusion or ADR	Higher risk of instability without fusion
Cosmetic Incision	Small transverse cut along neck crease (less visible)	Midline incision at the back of the neck (more visible)
Recovery & Return to Work	Faster — due to less tissue trauma Slower	Slower - longer healing due to muscle disruption

Why I Prefer the Anterior Approach

1. Direct Access to the Pathology

Most cervical disc herniations and osteophytes are located anterior to the spinal cord. The anterior approach allows me to

Directly visualize and decompress the disc space
Remove disc fragments and bone spurs completely
Restore disc height and foraminal diameter

Posterior surgery requires working around the spinal cord to reach the anterior pathology — which is less precise and carries more risk.

2. Less Muscle Disruption and Post-Op Pain

Anterior surgery avoids cutting through or stripping the large posterior cervical muscles (trapezius, splenius capitis, semispinalis, and multifidus). This leads to:

Less postoperative neck pain
Faster recovery
Better long-term strength and mobility

Posterior surgery, on the other hand, often results in more pain and longer recovery due to muscle trauma.

3. Superior Biomechanical Reconstruction

Using ACDF or ADR, I can:

Restore natural cervical lordosis
Stabilize unstable segments
Use implants (cages, plates, or artificial discs) to maintain alignment

This is especially important in multilevel disease or kyphotic deformity, where posterior decompression alone won't correct the underlying structural issue.

4. Lower Risk of Scar Tissue and Nerve Retethering

Posterior approaches like foraminotomy may relieve symptoms temporarily but don’t always remove the source of compression. Additionally:

Scar tissue from posterior surgery can re-tether the nerve
Anterior decompression removes the pathology at its source

This makes the anterior approach a more durable, long-term solution — particularly for younger patients, athletes, or those with recurrent symptoms.

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When Do I Choose Posterior Surgery?

Although I favor the anterior route, there are cases where posterior surgery is more appropriate, such as:

Multilevel congenital spinal stenosis
Posterior ligament hypertrophy (e.g., ligamentum flavum, OPLL)
Revision cases where anterior surgery was previously performed
When avoiding anterior neck scarring is preferred

In these situations, I perform laminoplasty, posterior foraminotomy, or laminectomy with fusion, depending on the patient’s condition and goals.

Real Patient Benefits I’ve Observed

Among the hundreds of anterior cervical surgeries I’ve performed, these are the most common outcomes:

Fast relief of neck, shoulder, and arm pain
Return to normal activity or work in 2–4 weeks
Minimal scarring (small incision in the neck crease)
Reduced need for post-operative pain medication
High satisfaction and frequent word-of-mouth referrals

Our Approach at DRHC Dubai

At Dr. Rami Hamed Center (DRHC) in Dubai Healthcare City, we take a comprehensive approach:

Advanced imaging and diagnostics
Intraoperative neuromonitoring for nerve safety
Individualized surgical plans (ACDF, ADR, or posterior techniques)
State-of-the-art equipment and surgical precision

Whether it's a single-level herniation or a complex multilevel deformity, every procedure is planned to maximize safety, function, and long-term relief.

Final Thoughts

“Anterior cervical surgery offers what every spine surgeon strives for: complete decompression, minimal disruption, and a stable spine. That’s why it remains my approach of choice — and why I see patients thriving after it, every week.”

If you're experiencing neck pain arm numbness, or weakness due to a cervical disc problem, I invite you to book a consultation. I’ll review your MRI, explain your options, and help you decide the best path to recovery.

Dr. Rami Hamed
Consultant Spine & Orthopedic Surgeon
Founder, DRHC – Dubai Healthcare City
📞 ‪+971 4 279 8800‬
🌐 www.drhc.ae
📍 Dubai Healthcare City, Building 52