Objective To investigate the clinical efficacy of endoscopy-assisted anterior cervical discectomy and fusion for cervical spondylosis. Methods The clinical data of patients treated with water medium endoscopy-assisted anterior cervical discectomy and fusion for cervical spondylosis at Mianyang Orthopedic Hospital between September 2021 and September 2023 were retrospectively collected. The surgical efficacy and nerve injury recovery were evaluated based on the Neck Disabilitv Index (NDI), Japanese Orthopaedic Association (JOA) score, improvement rate of JOA score, Cobb angle and height changes of the affected intervertebral space before surgery and at the last follow-up, as well as the occurrence of surgical complications. Results A total of 29 patients were included, including 18 males and 11 females. The average age was (52.34±8.96) years, and the average duration of illness was (17.31±6.60) months. The average follow-up time was (11.69±3.41) months. At the last follow-up, the patients’ NDI (3.55±3.09 vs. 17.28±5.51), Cobb angle [(15.25±4.83) vs. (−1.34±7.50)°], intervertebral height [(8.04±0.82) vs. (4.67±0.95) mm], and JOA score (15.90±1.11 vs. 11.17±1.65) improved compared to preoperative levels (P<0.05). The JOA score improvement rate assessment showed that 16 cases were excellent, 11 cases were fine, 2 cases were moderate, and the excellent and fine rate was 93.10%. All patients did not experience serious complications after surgery. Conclusion Water medium endoscopy-assisted anterior cervical discectomy and fusion for cervical spondylosis has good clinical efficacy and safety.