Eighty patients undergoing unilateral open-door laminoplasty were randomized to receive thrombin-gelatin matrix plus absorbable gelatin sponge (TGM-AGS, n=40) or absorbable gelatin sponge alone (AGS, n=40). The primary outcome of interest was intraoperative blood loss (IBL). Secondary outcomes included duration of operation, duration of hemostasis, drainage volume and days, maximum hemoglobin decrease, length of hospital stay, coagulation indicators, adverse events, and patient-reported outcome measures (PROMs). Outcomes were assessed up to hospital discharge. Overall, the results revealed that the TGM-AGS group had significantly lower IBL (75.22 ±21.83 mL vs 252.43 ±57.39 mL, p<0.01), shorter hemostasis duration, less postoperative drainage, fewer drainage days, and smaller hemoglobin reduction compared with the AGS group. PROMs improved similarly in both groups. These findings suggest that TGM-AGS provides superior intraoperative and postoperative hemostatic control over AGS alone.