Objective To compare the efficacy of posterior cervical open door enlarged spinal canal plasty with anterior cervical decompression and internal fixation for cervical hyperextension injury. Methods Fifty⁃seven patients with cervical hyperextension injury admitted to the orthopedic department of the hospital from June 2018 to December 2021 were selected，with 33 patients who underwent posterior cervical single⁃opening spinal canal expan⁃ sion plasty（group A）and 24 patients who underwent anterior cervical decompression and internal fixation（group B）. We retrospectively analyzed and compared the surgical and postoperative recovery indexes of the two groups，while discussing the efficacy and safety of different surgical approaches. Results The operative time，surgical bleeding， and hospital stay were less in group A than in group B（P < 0.05）；the JOA score and Frankel classification were slightly better in group A than in group B，the fusion segment height and Cobb angle were slightly higher than in group B，and the complication rate was slightly lower than in group B，but none of them were statistically different （P > 0.05）. Conclusion In patients with cervical hyperextension injury，either posterior single⁃opening spinal canal enlargement plasty or anterior decompression internal fixation can achieve a better outcome according to the imaging findings，but posterior single ⁃opening has less surgical risk and more complete decompression，which is worth giving priority to.