Objective To study the short-term effects and imaging changes of anterior cervical corpectomy and fusion (ACCF) and posterior cervical micro-titanium plate fixation combined with expansive laminoplasty (ELAP) in the treatment of multilevel cervical spondylotic myelopathy (MCSM). Methods The clinical data of 82 patients with MCSM surgery in our hospital were retrospectively analyzed. The patients were divided into ACCF group (n=35) and ELAP group (n=47) according to different surgical methods. Surgery-related indexes and neck pain VAS score and JOA score before and after surgery were analyzed in the two groups. X-ray plain film and CT images were used to calculate and compare the cervical curvature, sagittal diameter of spinal canal and cervical vertebra activity before surgery and at 6 months after surgery. Results The operative time in ACCF group was longer than that in ELAP group, and the intraoperative blood loss, postoperative drainage volume and average hospital stay were less than those in ELAP group (P<0.05). At 6 months after surgery, the VAS scores in the two groups were significantly decreases (P<0.05) while the JOA scores were significantly increased (P<0.05), and the differences between the two groups were not statistically significant (P>0.05). The cervical curvature and activity in the two groups were significantly decreased (P<0.05), and the sagittal diameter of spinal canal was increased significantly (P<0.05), and the cervical curvature and activity in ACCF group were higher than those in ELAP group, and the sagittal diameter of spinal canal was lower than that in ELAP group (P<0.05). The incidence rate of complications was 25.71% in ACCF group and 29.79% in ELAP group (P>0.05). Conclusion Both ACCF and ELAP can effectively relieve neck pain and improve cervical nerve function in the treatment of MCSM. Among them, ACCF has less trauma to patients, and it is beneficial to promote postoperative rehabilitation and reduce loss of cervical curvature and activity. And ELAP can enlarge activity space of spinal cord, and it can more effectively relieve spinal cord compression.