Objective <p>To compare the clinical and radiological outcomes between posterior laminectomy and laminoplasty hybrid decompression and laminectomy with lateral mass screw fixation in multilevel degenerative cervical myelopathy.</p> Methods <p>A total of 158 patients for multilevel degenerative cervical myelopathy (DCM) undergoing surgical treatment were enrolled in this study from May 2018 to December 2023, including 97 patients who underwent posterior laminectomy and laminoplasty hybrid decompression (PLLDH) and 61 patients treated with posterior lateral mass screw fixation (PLMSF). To minimize potential confounding factors, propensity score matching was employed for inter-group comparison. Neurological function scores and radiographic parameters were systematically compared between the two surgical groups.</p> Results <p>Following propensity score matching (PSM), baseline characteristics showed no statistically significant differences between the two surgical groups. The matched cohorts demonstrated that operative duration, intraoperative blood loss, VAS scores, Cobb angle, dural sac cross-sectional area at the narrowest level, and posterior dural displacement had no statistically significant differences(<i>P</i> &gt; 0.05). However, significant inter-group differences were observed in JOA scores (<i>P</i>&lt;0.05), NDI scores (<i>P</i>&lt;0.05), and cervical range of motion (<i>P</i>&lt;0.05) postoperatively.</p> Conclusion <p>Both PLLDH and PLMSF are effective surgical approaches for treating multilevel DCM, demonstrating satisfactory clinical outcomes. However, PLMSF resulted in greater postoperative loss of cervical mobility compared to PLLDH.</p>