Objective To evaluate the clinical effectiveness of Centerpiece system in cervical expansive open-door laminoplasty in elderly patients. Methods Fifty-five patients with cervical spondylotic myelopathy (CSM) undergoing cervical expansive open-door laminoplasty by Centerpiece mini titanium plate fixation (n＝27, mean age 68.3) from Feb. 2009 to Jan. 2010 or by traditional suture suspension (n＝28, mean age 67.5) from Jan. to Dec. 2008 in Department of Orthopedics, West China Hospital, Sichuan University, were enrolled in this retrospective case-control study. The clinical effectiveness was assessed by Japanese Orthopaedic Association (JOA) score, post-operative axial symptoms, C5 nerve root palsy, value of cervical curvature on X-ray film or CT scan, lamina opened angle, and the reclose of opened laminae. Results All patients were followed up for 24 months. There was no significant difference with regard to the improvement rate of JOA score between two groups (51.9% vs 51.8%, P＞0.05). Centerpiece group had significantly higher score in the postoperative axial symptoms than control group (10.3±1.3 vs 9.0±1.9, P＜0.05). C5 nerve root palsy was seen in one case from Centerpiece group and two cases out of control group, and it was relieved by conservative treatment. No significant difference was found in cervical curvature angle in Centerpiece group before operation and at the final follow-up [(17.9°±2.2°) vs (18.1°±2.4°), P＞0.05)], whereas statistical difference was seen in the control group with the angle larger before operation than that at the final follow-up [(17.8°±2.4°) vs (15.7°±2.0°), P＜0.05)]. CT scanning showed that the angle of the opened laminae was maintained and no reclosed open-laminae was seen at the final follow-up. Screw loosening in the laminae was observed in one case from Centerpiece group, but no relative symptom was found. Conclusion Sound clinical outcome is achieved in the treatment of CSM in elderly patients with cervical expansive open-door laminoplasty with Centerpiece titanium miniplate. The fixation reduces postoperative axial symptoms and prevents the loss of cervical curvature.