Eighty patients with single-level cervical spondylosis were randomized to receive uncovertebral joint fusion (UJF) (n=40) or end plate space fusion (ESF) (n=40). The primary outcome was the fusion rate at 3 months postoperatively. Secondary outcomes included complications and patient-reported outcomes (JOA, NDI, VAS-arm, and VAS-neck scores). Outcomes were assessed at 3, 6, and 12 months. Overall, the results revealed significantly higher early fusion rates in the UJF group at both 3 months (66.7% vs. 13.2%, p < 0.0001) and 6 months (94.1% vs. 66.7%, p = 0.006), with no significant difference at 12 months. PROMs and complication rates were comparable between groups. These findings suggest UJF leads to significantly faster early fusion without additional complications.