Background <p>Degenerative cervical myelopathy (DCM) is the primary cause of nontraumatic spinal cord injury in adults and the elderly. Laminoplasty (LP) offers benefits for cervical lordosis and laminectomy (LF) for spinal instability, prevention of fusion-related complications, and decreased dura mater constriction from scar tissue. Although it has some drawbacks, like hinge fractures and technical challenges, laminoplasty and other surgical methods are increasingly utilized to treat DCM by expanding the spinal canal.</p> Aim <p>The study assesses the safety and effectiveness of laminoplasty versus laminectomy with or without fusion in treating multilevel cervical spondylotic myelopathy (CSM).</p> Methods <p>This prospective study was carried out on 30 patients having spinal surgery, operated on for CSM. All patients were assessed pre- and postoperatively, with a full history and physical examination using the Visual Analog Scale (VAS) and modified Japanese Orthopedic Association (mJOA) systems. These patients were surgically split into laminoplasty and laminectomy groups to compare clinical safety. Data were analyzed using IBM SPSS version 20.0 with significant results at the 5%.</p> Results <p>This study involved 30 patients who underwent laminoplasty and laminectomy surgery at Alexandria Main University Hospital. Each group was performed in 50% of cases; 36.7% of laminectomy patients underwent laminectomy alone, while 13.3% required additional fusion. The laminectomy group had a higher mean age compared to the laminoplasty group (61.0 ± 6.01 vs. 55.40 ± 6.60 years, with <i>p =</i> 0.022). Postoperatively, both groups showed significant pain reduction and functional improvement <i>(p &lt;</i> 0.001<i>)</i> without differences in pain or function outcomes, indicating similar clinical effectiveness. The laminoplasty group experienced lower blood loss (169.3 ± 52.30 mL vs. 235.3 ± 42.74 mL, <i>p =</i> 0.001), shorter surgery duration, and hospital stays compared to the laminectomy group. Blood loss was correlated with hospital stay in the laminectomy group (rs = 0.747, <i>p</i> = 0.001), suggesting that greater intraoperative bleeding was associated with extended hospitalization.</p> Conclusion <p>Laminoplasty and laminectomy are safe surgical options for multilevel DCM management. The choice between LP and LF in CSM depends on cervical alignment and stability. Laminectomy is preferred for spinal instability, while laminoplasty is better for preserved cervical lordosis, providing pain relief, fewer complications, and lower costs.</p>