Objective: To study the safety and efficacy of anterior cervical HDF (hybrid compression and fusion) in the treatment of patients with multi-level cervical spondylotic myelopathy. Methods: Patients who treated with either HDF(single level ACDF + single level ACCF) or 3-levles ACDF for multi-level cervical spondylosis were enrolled and analyzed retrospectively. The data with regarding perioperative, pre- and post-operative imaging and clinical outcome were extracted for further comparison. Results: We evaluated 86 consecutive patients who underwent surgery for the treatment of multi-level cervical spondylosis at our institution from Aug. 2015 to Aug. 2019. In this series, 65 patients underwent 3-level ACDF and 21 patients underwent HDF. The blood loss significantly higher in HDF group(p<0.01); there was no significantly difference in the operation time and the incidence of major complications (dysphagia, hoarseness and C5 nerve root palsy) during perioperative period (p<0.05). At the final follow up, patients in both groups had equivalent significant improvement in their VAS value and NDI(both p<0.01); however, there was no group difference in VAS score (p=0.438) and NDI (p=0.954) improvement rate between the two groups. At the last follow-up, CL and OL were significantly improved in both groups after surgery (both p<0.01); also, no group difference was observed in both CL improvement (p=0.704) and OL improvement (p=0.697) between the two groups. In addition, there was no difference in the improvement of C2-7 SVA in both groups, and the improvement of C2-7 SVA after operation was no significant difference between the two groups (p>0.05). At the last follow-up, the success rate of fusion was 89.23% (58/65) in ACDF group and 71.43% (15/21) in HDF group. There was no difference between the two groups (p= 0.561). Conclusions: The procedure of HDF is a safe and effective alternative for multi-levels CSM patients who are not suitable for 3-levels ACDF.