Background: Both congenital and degenerative alterations can cause the cervical spinal canal to narrow in cervical spondylotic myelopathy (CSM), a common spine condition. This illness results in severe neurological impairment. Objective: This study aimed to compare the clinical outcomes of two treatments in patients with hourglass cervical spondylotic myelopathy: Anterior cervical discectomy and fusion (ACDF) alone and one-stage combined ACDF and posterior cervical laminectomy (PCL) at the same level in a single procedure. Patients and methods: Neurosurgery procedures at Menoufia University Hospital for cervical spondylotic myelopathy symptoms between 2017 and 2023. Group 1 consisted of 15 patients who underwent ACDF and PCL at the same level concurrently, while Group 2 consisted of 15 patients who underwent ACDF only. The combination strategy involved PCL and ACDF. Results: Although there was no statistical difference between Groups 1 and 2, the data demonstrated that both groups improved their VAS scores for axial pain at the final follow-up as compared to preoperative values. At the conclusion of the follow-up period, there was still a statistical difference between the two groups, suggesting that both groups had improved, and each group displayed a statistically significant change in the JOA score from preoperative values. Conclusion: When performed in conjunction with anterior cervical discectomy and fusion (ACDF), the adjunctive PCL treatment can safely and effectively treat hourglass CSM.