Objective To explore the changes in cervical curvature and their influencing factors after percutaneous posterior cervical endoscopic treatment for single segment cervical spondylotic radiculopathy.Methods 200 patients with single segment cervical spondylotic radiculopathy from January 2021 to March 2024 was selected, then divide them into control group and study group according to the random number table method. The control group received traditional open anterior cervical surgery, while the study group received percutaneous posterior cervical endoscopic treatment. Compare the treatment outcomes, surgical related conditions, cervical curvature and other sagittal parameters, pain levels, and cervical function between the two groups of patients. Using the generalized estimation equation (GEE) model to analyze the improvement degree of cervical curvature and other cervical sagittal parameters by two methods, and analyze the risk factors affecting changes in cervical curvature.Results The study group had significantly shorter surgical time, incision length, and hospitalization time compared to the control group. The intraoperative blood loss and hospitalization costs were also significantly lower than those of the control group, and the differences were statistically significant (P < 0.05). The excellent rate of the study group was significantly higher than that of the control group, and the difference was statistically significant (P < 0.05). The C_2-7 Cobb angle and T₁ tilt angle in the study group were significantly higher than those in the control group, the intervertebral height was significantly higher than that in the control group, and the C_2-7 sagittal vertical axis (C_2-7 SVA) was significantly smaller than that in the control group, with statistically significant differences (P < 0.05). At three months after surgery and the last follow-up, the visual analogue scale (VAS) scores and neck disability index (NDI) of the two groups of patients were significantly lower than those before treatment, and the study group was significantly lower than the control group. At three months after surgery and the last follow-up, the Japanese Orthopaedic Association (JOA) scores of the two groups of patients were significantly higher than those before treatment, and the study group was significantly higher than the control group, with statistically significant differences (P < 0.05). Intervertebral height ≤ 8 mm (OR＾ = 1.627, 95%CI: 1.401 ~ 1.938, P = 0.020), T₁ tilt angle ≤ 25° (OR＾ = 1.598, 95%CI: 1.381 ~ 1.934, P = 0.027), and no percutaneous cervical endoscopic treatment (OR＾ = 2.591, 95%CI: 1.673 ~ 3.998, P = 0.000) were independent risk factors affecting changes in cervical curvature. C_2-7 SVA ≤ 20 cm (OR＾ = 0.748, 95%CI: 0.601 ~ 0.928, P = 0.007) was a protective factor for changes in cervical curvature. According to GEE, the improvement of C_2-7 Cobb angle, intervertebral height, T₁ tilt angle, and C_2-7 SVA in the study group was significantly better than that in the control group, and the differences were statistically significant (P < 0.05).Conclusion Percutaneous posterior cervical endoscopic treatment can significantly improve the cervical cervical curvature and cervical sagittal plane parameters of patients with single segment cervical spondylotic radiculopathy, and the treatment effect is better than traditional open anterior cervical surgery. The surgical trauma is smaller, the cost is lower, the hospital stay is shorter, and the postoperative recovery is faster. It is worthy for clinical application.