Recent epidemiological data have revealed an increasing incidence of atlantoaxial (C1–C2) stenosis. In this study, we review the merits and limitations of traditional surgical techniques for the decompression and excision of atlantoaxial stenosis, and introduce a novel biportal endoscopy method. A retrospective analysis was conducted on 1562 cases extracted from 19 articles. These patients, diagnosed with cervical spondylotic myelopathy or cervical spondylosis with various etiologies, underwent surgery using either a posterior biportal endoscopic approach for cervical discectomy or cervical canal decompression. Additionally, we present two cases of atlantoaxial cervical spondylosis treated using the biportal endoscopy approach, yielding positive clinical and radiological outcomes. Common complications associated with spinal endoscopy surgery include dura injury, nerve root injury, hematoma, and recurrence of the condition. While endoscopic cervical spinal surgery shows promising results in terms of efficacy and safety, further detailed assessments of potential complications are necessary.