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BACKGROUND Although published data support the utilization of circumferential fusion to treat select cervical spine pathologies, it is unclear whether the posterior-anterior-posterior (PAP) fusion has increased risks compared with the anterior-posterior fusion. OBJECTIVE To evaluate the differences in perioperative complications between the 2 circumferential cervical fusion approaches. METHODS One hundred fifty-three consecutive adult patients who underwent single-staged circumferential cervical fusion for degenerative pathologies from 2010 to 2021 were retrospectively reviewed. Patients were stratified into the anterior-posterior (n = 116) and PAP (n = 37) groups. The primary outcomes assessed were major complications, reoperation, and readmission. RESULTS Although the PAP group was older (P = .024), predominantly female (P = .024), with higher baseline neck disability index (P = .026), cervical sagittal vertical axis (P = .001), and previous cervical operation rate (P < .00001), the major complication, reoperation, and readmission rates were not significantly different from the 360° group. Although the PAP group had higher urinary tract infection (P = .043) and transfusion (P = .007) rates, higher estimated blood loss (P = .034), and longer operative times (P < .00001), these differences were insignificant after the multivariable analysis. Overall, operative time was associated with older age (odds ratio [OR] 17.72, P = .042), atrial fibrillation (OR 158.30, P = .045), previous cervical operation (OR 5.05, P = .051), and lower baseline C1-7 lordosis (OR 0.93, P = .007). Higher estimated blood loss was associated with older age (OR 1.13, P = .005), male gender (OR 323.31, P = .047), and higher baseline cervical sagittal vertical axis (OR 9.65, P = .022). CONCLUSION Despite some differences in preoperative and intraoperative variables, this study suggests both circumferential approaches have comparable reoperation, readmission, and complication profiles, all of which are high.