Objectives: To investigate the clinical effect and safety of large-channel endoscopic unilateral laminotomy decompression for the treatment of multilevel cervical canal stenosis. Methods: A retrospective study was conducted on 36 Cervical spinal stenosis patients who underwent surgical treatment between January 2020–December 2023.Patients were divided into two groups according to the surgical method: endoscopic group(n=16) and open group(n=20).Perioperative Basic parameters were record and Clinical efficacy were systematically assessed using validated metrics: Visual Analog Scale , Japanese Orthopaedic Association score and Neck Disability Index. Radiographical parameters(C2–C7 Cobb angle, T1 slope, pavlov ratio) are used to assess the decompression effect and stability of cervical spine. Results: The endoscopic group demonstrated significant advantages over the open group in operative time , incision length , blood loss, and hospitalization duration . Both groups showed significant postoperative improvements in VAS, JOA, and NDI scores compared to preoperative baselines (P<0.05). At 1 month postoperatively, the endoscopic group exhibited superior VAS scores to the open group (2.69 ± 0.79 vs. 4.4 ± 0.88, P<0.05). Radiographic outcomes at final follow-up revealed significantly better cervical Cobb angle (13.57 ± 2.29° vs. 16.34 ± 2.95°, P<0.05) and T1 slope (22.62 ± 1.51° vs. 25.24 ± 2.41°, P<0.05) in the endoscopic group. Conversely, the open group demonstrated greater postoperative spinal canal area and Pavlov ratio (P<0.05). Conclusions: The large-channel endoscopic unilateral laminotomy decompression demonstrates satisfactory short-term efficacy in treating multilevel Cervical Spinal Stenosis. This technique offers significant advantages including reduced surgical trauma, accelerated recovery, enhanced postoperative cervical stability and higher patient satisfaction.