One hundred fifty-five patients with degenerative cervical myelopathy were randomized to receive either skip-fixation (instrumentation of every second opened level) (n=80) or all-fixation (instrumentation of every opened level) (n=75) during open-door cervical laminoplasty. The primary outcome was the difference in the Japanese Orthopaedic Association (JOA) score at 2 years postoperatively. Secondary outcomes included surgical data, complications, changes in JOA score, Neck Disability Index (NDI), EQ-5D-5L score, visual analog scale (VAS) score for neck pain, and radiographic outcomes. Outcomes were assessed at 1 and 2 years postoperatively. Overall, the results of the study revealed that skip-fixation was noninferior to all-fixation in terms of myelopathy improvement at 2 years. Additionally, skip-fixation was associated with a shorter surgical time (p = 0.010) and greater improvements in neck pain (p = 0.006), disability (p = 0.047), and quality of life (p = 0.037) compared with all-fixation. These findings suggest that skip-fixation may be a sufficient and potentially advantageous alternative to all-fixation in open-door cervical laminoplasty.