[Objective] To compare the clinical outcomes of three-dimensional (3D) exoscopic anterior cervical discectomy and fusion (ACDF) and conventional ACDF for the treatment of cervical spondylotic myelopathy. [Methods] This retrospective study was performed on 33 patients with cervical spondylotic myelopathy who underwent 3D exoscopic ACDF (exoscope group) or conventional ACDF (conventional group) from March 2018 to June 2019. Operation time and intraoperative blood loss were recorded. The neck disability index (NDI), Japanese orthopaedic association scores (JOA), neurological function improvement rate, as well as the area of dural sac and C2~C7 Cobb angle measured on images were used to evaluate the clinical outcomes. [Results] The operation time in the exoscope group was longer than that in the conventional group (P＜0.05). The intraoperative blood loss in the exoscope group was less than that in the conventional group (P＜0.05). The NDI scores, JOA scores, and the area of dural sac at the last follow-up were improved (P＜0.05). No difference was found in the rate of neurological function improvement between the two groups (P>0.05). The C2~C7 Cobb angle of the two groups was not improved compared with those before surgery. [Conclusion] The 3D exoscope can provide excellent illumination and magnification with advantages of working distance and ergonomics. 3D exoscopic ACDF provides satisfactory short-term clinical outcomes in the treatment of cervical spondylotic myelopathy, which is equal to the conventional ACDF.