Background: Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord dysfunction in adults over 55, resulting from degenerative cervical changes that compress the spinal cord and lead to functional impairment. Laminoplasty, a posterior decompression technique, is widely used for multilevel cervical stenosis, preserving spinal stability while improving neurological outcomes. Objective: To evaluate the functional and neurological outcomes of en-bloc cervical laminoplasty in patients with CSM and to identify prognostic factors influencing recovery. Methods: This retrospective study included 85 patients who underwent en-bloc cervical laminoplasty at different private hospital and Bangabandhu Sheikh Mujib Medical University Bangladesh between January 2007 and June 2019. Preoperative symptom duration was categorized as <6 months, 6–18 months, and >18 months. Neurological and functional status were assessed using the modified Japanese Orthopaedic Association (mJOA) score and Nurick grading scale. Postoperative recovery rates were calculated using the Hirabayashi method. Data were analyzed using SPSS 22, with Fisher’s exact test, ANOVA, and Spearman’s correlation applied as appropriate. A p-value <0.05 was considered significant. Results: The mean age of patients was 65.8 ± 8.9 years, with 62.35% males. Multilevel stenosis was common, with four-level involvement in 37.65% of patients. Patients with shorter symptom duration (<6 months) achieved the best neurological recovery, with all reaching mJOA scores >15. Recovery rates varied according to preoperative mJOA and Nurick scores: complete recovery was observed in 75.0% of patients with mJOA ≥15 and 75–100% of patients with Nurick grades 0–2, whereas those with mJOA <12 or Nurick grades 3–4 experienced partial recovery, no change, or worsening. Conclusion: Early surgical intervention in CSM is associated with superior neurological outcomes. Higher preoperative mJOA scores, lower Nurick grades, and shorter symptom duration were strong predictors of complete recovery, while prolonged symptoms and severe baseline deficits limited postoperative improvement. These findings underscore the importance of timely diagnosis and surgical management in optimizing patient outcomes.