【Abstract】objective To compare microscope-assisted and traditional anterior approach in the treatment of cervical spondylotic myelopathy (CSM) and to explore the clinical effect of the combined application of microscope and zero-profile Methods A total of 42 patients with CSM from September 2016 to July 2018 were reviewed. They were divided into a microscopic group (n = 26) and a traditional group (n = 16) for a randomized controlled analysis. Gender, age, smoking, operative time, intraoperative and postoperative blood loss, postoperative catheter indwelling time, cervical Cobb angle, JOA and improvement rate, NDI and postoperative complications were recorded in the two groups. Results There were no statistically significant differences in general preoperative data. The microscopic group had significantly less amount of intraoperative blood loss and postoperative drainage volume than the traditional group（P＜0.01），regardless of no significant differences in operative time and postoperative catheter indwelling time between the two groups（P＞0.05）. Both JOA and NDI in the two groups significantly improved after operation compared with those before operation, and the scores 12 months after surgery were significantly improved compared with those 1 month after surgery (P < 0.01). One month after the operation,the JOA, improvement rate and NDI in the microscopic group were better than those in the traditional group (P < 0.01). However no statistically significant differences regarding the JOA, improvement rates and NDI between the two groups before and 12 months after surgery (P > 0.05).The Cobb angle in the two groups significantly improved after operation compared with before operation(P < 0.01). However, no statistically significant difference regarding Cobb angle were proved at 1 month and 12 months after surgery as well as before surgery between the two groups(P > 0.05).Conclusions Compared with the traditional, anterior approach of microscope-assisted fusion with zero-profile, it has the advantages of less intraoperative bleeding and postoperative drainage, faster and better postoperative cervical spine function improvement, and the improvement of cervical spine function in both groups is higher than before over time.The curvature of cervical spine was improved after operation compared with that before operation.