Objective:

To compare biportal endoscopic laminectomy (BE-L) with open-door laminoplasty (OD-L) for multilevel cervical myelopathy (CM) focusing on neurological recovery, perioperative burden, and sagittal alignment.

Approach:

• Study Design: A prospective observational study enrolling 128 patients with 2–3 level CM from November 2022 to May 2024, using propensity score matching to create 50 matched pairs.

Key Findings:

• BE-L resulted in shorter operative time, lower perioperative hemoglobin drop, and shorter hospital stay compared to OD-L.
• At 3 months, mJOA scores favored BE-L, but the difference was not clinically significant at 6 or 12 months.
• Early NDI and VASneck scores favored BE-L, converging by 12 months.
• No significant differences in C2–C7 Cobb angle were observed at any time point.
• Four transient neurological deficits occurred in the BE-L group during the initial learning curve.

Interpretation:

BE-L achieves 12-month neurological and functional outcomes comparable to those of OD-L, with advantages in early postoperative recovery and shorter hospitalization.

Limitations:

• Thestudyisobservationalandnotrandomized,whichmaylimitthestrengthoftheconclusions.Additionally,thesamplesizemaylimitthegeneralizabilityoffindings.

Conclusion:

BE-L represents a viable minimally invasive alternative for carefully selected patients with 2–3 level CM.