Background: Posterior cervical foraminotomy (PCF) cannot widen the neural foramen vertically, whereas anterior cervical discectomy and fusion (ACDF) could increase foraminal height (FH) by distracting the disc space.

Purpose: To compare the clinical and radiographic outcomes between ACDF and PCF in patients with cervical radiculopathy and vertically narrow foramina (FH <6 mm).

Study Design: Retrospective cohort study.

Patient Sample: Patients who underwent single- or multilevel ACDF (n=44) or PCF (n=33) between 2015 and 2022 and had at least one neural foramen with FH <6 mm were retrospectively analyzed.

Outcome Measures: Clinical outcomes included visual analog scale (VAS) scores for neck and arm pain and the Neck Disability Index, assessed preoperatively and at 3 months and 2 years postoperatively. Radiographic parameters included FH, C2-C7 sagittal vertical axis, and cervical range of motion. Revision surgery rates and causes were also evaluated.

Methods: Between-group comparisons of continuous variables were conducted using Student's t test, whereas categorical variables were analyzed using the chi-squared test. Paired t tests were used to compare repeated measures over time. Intraobserver reliability of radiographic measurements was assessed using intraclass correlation coefficients.