Abstract:[Objective] To compare the clinical outcomes of anterior reduction and instrumented fusion versus posterior counterpart forlower cervical spine fractures and dislocations (LCSFD) with spinal cord injury (SCI). [Methods] A retrospective research was performed on80 patients received surgical treatment for LCSFD combined with SCI from September 2018 to August 2022. According to doctor-patientdiscussion, 40 patients had operation performed through the anterior approach (AA), while the other 40 patients were through the posteriorapproach (PA). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups wereoperated on smoothly, and the AA group proved significantly superior to the PA group in terms of operation time [(95.0±10.4) min vs (123.5±13.6) min, P＜0.001], the total incision length [(3.5±0.6) cm vs (11.2±2.0) cm, P＜0.001], intraoperative fluoroscopy times [(3.6±1.2) times vs(6.5±1.5) times, P＜0.001], intraoperative blood loss [(96.2±14.6) ml vs (254.5±30.5) ml, P＜0.001], postoperative drainage [(40.2±8.7) ml vs(66.0±12.4) ml, P＜0.001], hospital stay [(8.2±2.6) days vs (12.5±3.8) days, P＜0.001] and the time to resume full weight-bearing activity[(74.2±12.0) days vs (83.5±14.6) days, P=0.003]. The VAS, NDI, JOA scores and ASIA grades in both groups were significantly improvedas time went on (P＜0.05). The AA group was significantly better than the PA group in terms of VAS score [(2.0±0.4) vs (2.4±0.5), P＜0.001],NDI [(26.1±5.3) vs (29.0±5.6), P=0.020] and the JOA score [(13.6±2.3) vs (12.3±2.1), P=0.010] 3 months postoperatively, as well as theVAS score at the last follow-up [(1.5±0.3) vs (1.7±0.4), P=0.013]. In term of imaging, the local kyphotic angle, injured vertebral slippage,relative height of intervertebral space and vertebral canal area of affected segment were significantly improved in both groups after surgerycompared with those preoperatively (P＜0.05). The AA group was significantly better than the PA group in terms of local kyphotic angle[(4.2±0.8)° vs (5.0±1.6)°, P=0.006], the injured vertebral slippage [(2.0±0.4) mm vs (2.4±0.6) mm, P＜0.001] 7 days postoperatively, as wellas injured vertebral slippage [(2.1±0.5) mm vs (2.5±0.9) mm, P=0.016] at the latest follow-up. [Conclusion] The anterior reduction and in-strumented fusion for LCSFD complicated with SCI has the characteristics of less trauma, faster postoperative recovery, and is more condu-cive to the restoration of spinal nerve function.