<h3>BACKGROUND CONTEXT</h3> Cervical spondylotic myelopathy (CSM) is a progressive degenerative condition that can lead to functional deficits and gait instability. Biomechanical changes to a patient's dynamic and postural stability after decompressive surgery are poorly understood. <h3>PURPOSE</h3> The aim of this study was to determine how spatiotemporal gait parameters, postural stability and dynamic stability change after decompressive surgery in patients with CSM. <h3>STUDY DESIGN/SETTING</h3> Prospective cohort study. <h3>PATIENT SAMPLE</h3> Patients aged 40 to 80 years old with Nurick grade 2 or 3 CSM spanning one to four levels undergoing decompressive surgery were prospectively enrolled in this study. Decompression surgery was defined as decompression with or without fusion of the cervical vertebra. Exclusion criteria included: patients who could not ambulate independently, had a history of surgery within 6 months of initial gait evaluation or gait altering lower extremity surgery. <h3>OUTCOME MEASURES</h3> A tilted ellipse area with bidirectional variance was used to assess postural stability metrics. Generated ground reaction forces (GRF) and variation in bidirectional center of pressure (CoP) motion were recorded and represented in an ellipse area around patient-generated CoP. Additionally, the analysis consisted of the examination of the following spatiotemporal gait parameters: stride length (distance over the ground between ipsilateral heel strikes), cadence (steps per minute), velocity (the speed of the patient's center of mass (CoM), step width (distance between two feet during period of double support), toe-off (percentage of the pre-swing portion of the gait cycle where ipsilateral limb leaves the ground and initializes single leg support) and double support (percentage of gait cycle spent with two feet on the ground). Dynamic stability of gait is inversely proportional to angular momentum regulation, where greater stability is shown by minimizing angular momentum excursion. Angular momentum was calculated using exported joint centers and joint angles, where each segment's angular momentum was computed as the sum of its local angular momentum and the angular momentum of the segment about the whole-body CoM, which was taken to be the sum of 15 body segments. <h3>METHODS</h3> A total of 47 subjects, including 23 Nurick grade 2 or 3 CSM patients and 24 controls, were included. Measurements were taken at baseline in both cohorts and then at 3- and 6-months following decompression in the CSM cohort. Standing balance trials were performed on a single force plate, and walking trials were conducted at a self-selected pace over a 15m runway and a series of five force plates. All trials were recorded with 3D motion analysis cameras, and gait modeling software was utilized. Repeated measures ANOVA was used to compare measurements at three timepoints, followed by paired t-tests. The significance value was set at P<0.05. <h3>RESULTS</h3> Patients with CSM had a significant increase in gait velocity postoperatively at 6 months (0.948 ± 0.248 m/s) compared to baseline (0.852 ± 0.257 m/s) (P = 0.008). CSM patients had a significant decrease in tilted ellipse area from baseline (979.8 ± 856.7 mm2) to 6 months (598.0 ± 391.1 mm2) (P = 0.018) postoperatively. There was no significant difference in angular momentum excursion between baseline and postoperative measurements. <h3>CONCLUSIONS</h3> Decompressive surgery in CSM patients was associated with significant improvement in gait velocity and postural stability. However, there was no significant change in dynamic stability throughout the study period. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.