Objective To evaluate the clinical efficacy of V-shaped stealth decompression technique using ultrasonic bone scalpel in anterior surgery for adjacent two-level cervical spondylosis. Methods A clinical data of 41 patients with adjacent two-level cervical spondylosis, who admitted between January 2020 and December 2023 and met the selection criteria, was analyzed retrospectively. Among them, 22 cases were treated with anterior cervical discectomy and fusion (ACDF) assisted by V-shaped stealth decompression technique using ultrasonic bone scalpel (group A) and 19 cases with anterior cervical corpectomy and fusion (ACCF) (group B). There was no significant difference between the two groups in age, gender, disease duration, surgical segment, preoperative Japanese Orthopedic Association (JOA) score, cervical dysfunction index (NDI), pain visual analogue score (VAS), and the anteroposterior diameter of the spinal canal in the responsibility space of CT cross section (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospitalization time, complications during follow-up, JOA score, NDI, and VAS score at last follow-up, and the incidences of intervertebral fusion at 3 months after operation and vertebral subsidence at last follow-up were compared between the two groups. Results The operations in both groups were successfully completed. The operation time, intraoperative blood loss, postoperative drainage volume, and hospitalization time in group A were significantly less than those in group B (P<0.05). Two cases (9.1%) in group A and 4 cases (21.1%) in group B developed complications, with no significant difference in incidences between the two groups (P>0.05). All patients in the two groups were followed up 6-12 months (mean, 9.3 months). There was no significant difference in follow-up time between the two groups (P>0.05). At last follow-up, the JOA score and VAS score in both groups significantly improved when compared with those before operation (P<0.05). The change values of VAS score and the improvement rate of JOA score in group A were significantly superior to group B (P<0.05). Imaging reexamination showed that the rate of intervertebral fusion at 3 months after operationwas significantly higher in group A (81.8%) than in group B (52.6%) (P<0.05), and all patients obtained bony intervertebral fusion at last follow-up. At last follow-up, 2 cases (9.1%) in group A and 11 cases (57.9%)in group B had cage sinking, and the difference in the incidence was significant (P<0.05). No loosening or fracture of internal fixators occurred in all patients. Conclusion Using ultrasonic bone scalpel can transform single vertebral ACCF into two-segment ACDF in anterior cervical spondylosis surgery. The"V-shaped" stealth decompression technique is safe and efficient, with the advantages of minimal trauma, fewer postoperative complications, and rapid recovery of patients.