Objective To comparatively analyze the efficacy differences between unilateral open-door laminoplasty and combined foraminoplasty in treating mixed (myelopathic and radiculopathic) cervical spondylopathy. Methods Patients with mixed (myelopathic and radiculopathic) cervical spondylopathy who underwent the two surgical procedures at the Third People’s Hospital of Chengdu between January 2017 and December 2023 were retrospectively selected. According to the surgical method, patients were divided into the open-door surgery group and the combined surgery group. The basic information, surgical related indicators, clinical efficacy scores, and complications between the two groups were compared. Results A total of 65 patients were included. Among them, there were 38 males and 27 females; 30 cases in the open-door surgery group and 35 cases in the combined surgery group; The average follow-up period was (18.6±6.8) months. There were no statistically significant differences in age, gender, surgical stage, and disease duration among the groups (P>0.05). Except for the operation time (P<0.05), there was no statistically significant difference in incision length and intraoperative bleeding between the two groups (P>0.05). There was no statistically significant difference in preoperative Visual Analogue Scale and Japanese Orthopaedic Association Score between the two groups (P>0.05). The difference in Visual Analogue Scale and Japanese Orthopaedic Association Score between the two groups six months after surgery was statistically significant (P<0.05). No severe complications such as surgical failure, uncontrollable hemorrhage, or intraoperative nerve/spinal cord injury occurred. No significant cervical instability occurred in either group. Conclusions For treating mixed (myelopathic and radiculopathic) cervical spondylopathy, unilateral open-door laminoplasty combined foraminoplasty may reduce the incidence of nerve root palsy and yield superior clinical outcomes compared to laminoplasty alone. This combined approach does not increase surgical risk and may potentially avoid the need for revision anterior cervical surgery.