Two hundred and sixty-five patients with cervical radiculopathy were included in this randomized trial assessing the non-inferiority of posterior cervical foraminotomy (n=132) compared to anterior cervical discectomy with fusion (n=133). The primary outcomes of interest were success rate (excellent or good on the Odom criteria) and arm pain on a Visual Analog Scale (VAS), tested for non-inferiority (with corresponding 1-sided confidence intervals [CIs]). Secondary outcomes and safety-outcomes were tested for superiority (with corresponding 2-sided CIs). Outcomes were assessed at 1 year post-operation. Posterior surgery was found to be non-inferior with respect to both arm pain and success rate compared to anterior surgery. However, the change from baseline in arm pain scores was not found to be non-inferior; the difference between groups was not clinically relevant, based on the proportion of patients who reached the minimal clinically important difference. No differences in secondary or safety outcomes were observed. Thus, posterior cervical foraminotomy can be considered as a non-inferior clinical alternative to anterior cervical discectomy with fusion based on the results of this study.