Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in the world. There are multiple types of anterior approaches for treating patients with DCM. Many strategies have been developed to reduce complications for multilevel anterior surgery. Posterior approaches are sometimes used to supplement more extensive anterior approaches. More recently, multilevel cervical arthroplasty has been used for this condition. More data soon will be available comparing anterior and posterior approaches with the goal of optimizing patient-related quality of life and reducing complications, which include dysphagia, weakness, and instrumentation failure in some cases.