Many disorders of the cervical spine can be effectively treated through a posterior approach. Generally, posterior decompressions such as a laminectomies, laminoplasties, and/or foraminotomies result in fewer postoperative complications compared with anterior approaches for multilevel surgery. Complications can include dysphagia, dysphonia, and pseudarthrosis. Fusion is indicated in spinal conditions that involve cervical instability, subluxation, or severe sagittal imbalance. During the past decade, techniques have been developed for instrumentation of the upper and subaxial cervical spine. Several recent studies have led to a better understanding of the cervical spine anatomy, which has helped limit complications and facilitate surgical procedures.