Eighty patients with multilevel cervical compressive myelopathy undergoing unilateral open-door laminoplasty were randomized to receive thrombin-gelatin matrix combined with absorbable gelatin sponge (TGM-AGS) (n=40) or absorbable gelatin sponge alone (AGS) (n=40). The primary outcome was intraoperative blood loss (IBL). Secondary outcomes included duration of hemostasis, volume of drainage, days of drainage, maximum hemoglobin decrease, adverse events, coagulation indices, and patient-reported outcome measures. Outcomes were assessed intraoperatively and through postoperative day 3, with adverse events monitored up to 4 weeks post-discharge. Overall, the results of the study revealed that the TGM-AGS group experienced significantly lower IBL, shorter hemostasis time, and less postoperative drainage than the AGS group. The main finding suggests that combining TGM with AGS is more effective for achieving hemostasis and reducing blood loss during cervical laminoplasty than AGS alone.