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
When treating cervical spine problems like:
The choice of surgical approach significantly impacts patient outcomes. Here’s a direct comparison:
| 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? | ||
| 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 |
Most cervical disc herniations and osteophytes are located anterior to the spinal cord. The anterior approach allows me to
Posterior surgery requires working around the spinal cord to reach the anterior pathology — which is less precise and carries more risk.
Anterior surgery avoids cutting through or stripping the large posterior cervical muscles (trapezius, splenius capitis, semispinalis, and multifidus). This leads to:
Posterior surgery, on the other hand, often results in more pain and longer recovery due to muscle trauma.
Using ACDF or ADR, I can:
This is especially important in multilevel disease or kyphotic deformity, where posterior decompression alone won't correct the underlying structural issue.
Posterior approaches like foraminotomy may relieve symptoms temporarily but don’t always remove the source of compression. Additionally:
This makes the anterior approach a more durable, long-term solution — particularly for younger patients, athletes, or those with recurrent symptoms.
Although I favor the anterior route, there are cases where posterior surgery is more appropriate, such as:
In these situations, I perform laminoplasty, posterior foraminotomy, or laminectomy with fusion, depending on the patient’s condition and goals.
At Dr. Rami Hamed Center (DRHC) in Dubai Healthcare City, we take a comprehensive approach:
Whether it's a single-level herniation or a complex multilevel deformity, every procedure is planned to maximize safety, function, and long-term relief.
“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