Laminectomy is an effective surgical treatment for multi-segment cervical spondylotic myelopathy (M-CSM) but usually results in C5 palsy. Some surgical techniques to restore the spinal sequence, increase the intervertebral foramen diameter, and limit the spinal cord drift distance have been proposed; however, it is unclear whether these procedures can avoid this complication.To investigate the clinical efficacy of limited laminectomy and foraminal decompression with fixation (LLFDF) for improving neurological recovery and preventing C5 palsy.A total of 71 patients with M-CSM were retrospectively analyzed. Thirty-nine of them were treated with LLFDF (group A) and 32 with normal laminectomy with fixation (NLF; group B) after 3 months of formal conservative treatment. Pre- and postoperative neurological function, spinal cord drift distance, cervical curvature index (CCI), and number of C5 palsy cases were recorded and analyzed.There was no significant intergroup difference in the surgical time or intraoperative blood loss (P >.05). The laminectomy widths in groups A and B were 16.7 ± 2.6 mm and 21.8 ± 2.9 mm, respectively (P <.01), while the spinal cord drift distances were 2.3 ± 0.4 mm and 3.6 ± 0.7 mm, respectively (P <.01). The mean Japanese Orthopedic Association score of both groups increased significantly after surgery (P <.01), and no significant difference was noted at any observation time points (P >.05). Both groups demonstrated significant CCI improvements after surgery compared with those before surgery (P <.01). There were 2 cases of C5 palsy in group A (5.1%) and 8 cases in group B (25.0%), and the difference was significant (P <.05).LLFDF can relieve spinal compression and considerably promote neurological recovery. Moreover, it restricts excessive spinal cord back drifting and decreases the incidence of C5 palsy.