Objective To compare the effectiveness of anterior intervertebral osteotomy and fusion (AIOF), utilizing the inflection point of the uncinate process (IPUP) as an auxiliary positioning landmark, versus conventional anterior cervical discectomy and fusion (ACDF) for the treatment of cervical spondylotic myelopathy (CSM). Methods A retrospective analysis was conducted on the clinical data of 60 patients with CSM who met the selection criteria and were admitted between June 2021 and December 2024. Among them, 32 patients underwent AIOF using the IPUP as an auxiliary positioning landmark (AIOF group), and 28 patients underwent ACDF (ACDF group). Baseline characteristics—including gender, age, surgical segments, preoperative visual analogue scale (VAS) score for pain, Japanese Orthopaedic Association (JOA) score, cervical lordosis angle, and the spinal cord cross-sectional area and spinal cord diameter at the surgical segments—showed no significant difference between the two groups (P>0.05). Operation time, intraoperative blood loss, and the incidence of complications were recorded for both groups. Functional recovery and pain relief were evaluated using JOA and VAS scores preoperatively, at 3 months postoperatively, and at last follow-up. The cervical lordosis angle (C2-C7 Cobb angle) and the spinal cord cross-sectional area and spinal cord diameter at the surgical segments were also measured. Interbody fusion and Cage subsidence rates were assessed at last follow-up. Results Operations were successfully completed in all patients, with no significant difference in operation time or intraoperative blood loss between the two groups (P>0.05). Postoperative dysphagia occurred in 2 cases (6.3%) in the AIOF group and 3 cases (10.7%) in the ACDF group, showing no significant difference (P>0.05). Neither group experienced complications such as hoarseness, cerebrospinal fluid leakage, dural tear, spinal cord injury, choking on water, or C5 nerve root palsy. All patients completed the follow-up, with the follow-up durations of (14.6±2.3) months in the AIOF group and (15.1±2.1) months in the ACDF group, showing no significant difference (t=0.852, P=0.398). No loosening or breakage of internal fixator was observed during follow-up, and complete bony fusion was achieved in all surgical segments. At last follow-up, no Cage subsidence occurred in either group. At 3 months postoperatively and at last follow-up, JOA scores, VAS scores, cervical lordosis angles, and the spinal cord cross-sectional area and spinal cord diameter at the surgical segments significantly improved when compared with preoperative values in both groups (P<0.05). Except for the cervical lordosis angle, which showed no significant difference between the two groups (P>0.05), the AIOF group demonstrated superior outcomes compared to the ACDF group in JOA score, VAS score, and the spinal cord cross-sectional area and spinal cord diameter at the surgical segments (P<0.05). Conclusion AIOF using the IPUP as an auxiliary positioning landmark provides satisfactory effectiveness in treating CSM. It is superior to traditional ACDF in improving neurological function, relieving pain, and restoring spinal cord morphology without increasing the risk of complications, representing a safe and effective surgical procedure.