Conventional cervical laminoplasty requires extensive paraspinal muscle detachment, frequently causing severe postoperative axial neck pain. While minimally invasive modifications exist, they often involve prolonged operative times. We evaluated the operative protocol and clinical outcomes of a novel ultra-minimally invasive technique—Open-door Plasty for Early Recovery Approach (OPERA)—in 300 consecutive patients with cervical myelopathy. Through a 3-cm midline incision, the C3–C6 spinous processes were sagittally split under a standard operating microscope, completely preserving bilateral paraspinal muscle attachments. Bilateral gutters were created rapidly by relying entirely on direct microscopic visualization of strict anatomical landmarks. The laminae were elevated and stabilized using mini-plates. The mean skin-to-skin operative time was remarkably short at 41.2 ± 8.5 minutes, with a mean estimated blood loss of 15.3 g. There were no instances of incision extension, conversion to open surgery, or intraoperative neurovascular complications. At the 1-year follow-up, the mean Japanese Orthopaedic Association score improved significantly from 10.4

± 2.1 to 14.6 ± 1.5, representing a recovery rate of 63.6% (P < 0.001). The Visual Analog Scale for axial neck pain decreased substantially from 48.5 ± 15.0 mm preoperatively to 15.2 ± 10.5 mm postoperatively (P < 0.001), indicating excellent preservation of the posterior dynamic tension band. Transient C5 palsy occurred in 7 patients (2.3%), all resolving completely. In conclusion, the OPERA technique via a 3-cm incision is a highly efficient, safe, and reproducible alternative to traditional laminoplasty. By synergizing strict muscle preservation and microscopic visualization, OPERA achieves unprecedented reductions in operative time and blood loss while excellently preventing postoperative axial neck pain.