SummaryDefinitive treatment of cervical spinal stenosis for patients with substantial or progressive impairment of neurologic function without any sustained remission is operative. The source of spinal compression, the number of vertebral levels involved in the spondylosis, sagittal alignment, and surgeon preference are criteria that must be factored into whether an anterior or posterior cervical approach is used. Historically, laminectomy has been favored for posterior decompression, but the resultant instability, kyphosis, and late neurologic deterioration have decreased the enthusiasm for laminectomy alone. Even with the addition of a posterior fusion procedure, laminectomy and fusion have met with limited success because of the rate of complications, including kyphotic alignment, subjacent level degeneration, and progression of myelopathy. The advantages of laminoplasty include the preservation of motion, the reduction of adjacent segment degeneration, and the absence of fusion-related complications such as nonunion, autograft site discomfort, and instrumentation failure. However, laminoplasty is not without its difficulties because the creation of the “troughs” and “hinges” can be technically demanding.