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【目的】探讨单一后路、后‐前路联合两种不同入路术式治疗合并颈椎后纵韧带骨化（Ossification of posterior lon‐gitudinal ligament ，OPLL）的重度脊髓型颈椎病的适应证及临床疗效。【方法】对44例合并颈椎 OPLL 的重度脊髓型颈椎病患者分别行颈椎后路单开门椎管扩大成形术（A 组，21例）和后‐前联合入路手术（B 组，23例）。比较两组患者手术时间及出血量、椎管狭窄率、骨化节段及脊髓压迫率的差异，并分析术前及术后随访时的 JOA 评分并计算改善率，评价两组患者的脊髓神经功能恢复情况。【结果】所有病例随访12～30个月，平均20个月，术中未出现脊髓、椎动脉损伤等严重并发症，A 组手术时间较 B 组手术时间短，两组有统计学差异（ P ＜0．05）；A 组出血量较 B 组出血量少，术中出血量的差异有统计学意义（ P ＜0．05）。两组脊髓功能均获不同程度改善。 A 组 JOA 评分从术前平均（7．2±2．1）分提高至术后1年平均（12．1±2．7）分，平均改善率为（57．3±5．2）％；B 组 JOA 评分从术前平均（6．8±1．6）分提高至术后1年平均（13．9±0．9）分，平均改善率为（69．8±4．5）％，两组患者术后1年 JOA 评分较术前均有明显提高，两组患者脊髓功能改善率对比 B 组优于 A 组，差异有统计学意义（ P ＜0．05）。【结论】采用后路或后‐前联合入路治疗合并颈椎 OPLL 的重度脊髓型颈椎病，均取得良好的临床疗效，根据不同的病例特点，选择合适的术式是取得较好临床疗效的关键。但对前后路均受压且椎管狭窄严重的患者，行一期后‐前路联合手术近期疗效优于单一的颈椎后路手术。“,”Objective]To explore the clinical outcome of the posterior approach and posterior‐anterior approach surgical treatment for severe cervical spondylotic myelopathy with ossification of posterior longitudinal ligament (OPLL) .[Methods]A total 44 cases of patients with severe cervical spondylotic myelopathy complicated with OPLL were categorized according to ap‐proach method into group A ,the posterior approach group with 21 cases and group B ,the posterior‐anterior approach group with 23 cases .Surgical treatment of patients in both groups was retrospectively analyzed .Operation time ,intraoperative blood loss ,spinal canal occupying rate ,degree of OPLL ,and cord flattening rate were evaluated between the two groups .According to the criteria of JOA (provided by Japanese Orthopaedic Association) ,preoperative score and postoperative follow‐up score in the two groups were compared and the improvement rates were calculated .[Results] All cases were regularly followed up for an average duration of 20 months (ranged 12 ~ 30 months) .The operation time and bleeding amount between the two groups had statistically significant differences ;the operation time of group A was shorter than that of group B and there was less bleeding in group A than there was in group B .The spinal function was improved in all 44 patients ,and no severe complications such as cord or vertebral artery injury occurred .In group A ,the preoperative mean scores of JOA was 7 .2 2 .1 and the postoperative JOA score was 12 .1 2 .7 (evaluated 12 months after surgery) ;the mean improvement rate was (57 .3 5 .2)% .In group B ,the preoperative mean scores of JOA was 6 .8 1 .6 ,the postoperative JOA scores was 13 .9 0 .9 (evaluated in 12 months after surger‐y) ,and the mean improvement rate was 69 .8 4 .5% .The mean improvement in group B was significantly more than in group A ( P < 0 .05) .[Conclusion]The appropriate approach of surgical treatment for severe cervical spondylotic myelopathy with OPLL can provide satisfying results .It is important to select a suitable surgical approach according to the characteristics of the case . However ,the posterior‐anterior approach is more effective in the treatment of severe cervical spondylotic myelopathy with OPLL than the posterior approach .