Anterior cervical spine surgery, as a commonly used treatment for primary diseases of the anterior spine column, is becoming more and more widely used in clinical practice because of its ease of exposure, ease of operation, efficacy, and few complications. Commonly used anterior cervical spine surgery can be divided into three types, namely, trans-oral anterior surgery, anterolateral cervical access surgery, and trans-anterior sternal splitting surgery. The anterior cervical approach is a powerful supplement to the posterior approach and provides more options for the treatment of anterior cervical column diseases. However, there are many details that need to be noted in the selection and operation of the surgical procedure. 1.Trans-oral anterior surgery Trans-oral anterior surgery is applicable to the operation of C0 (base of occipital condyle) to C2 vertebral segments, but the neck must be kept in the hyperextended position, and a special retractor is also required to make the mouth open wide to fully expose the incision site. Once the anterior atlantoaxial (C1) node is selected to determine the location of the transoral anterior surgical incision, it is important to remember that the distance of the incision from the midline should not exceed 15 mm to prevent injury to both vertebral arteries. 2.Anterolateral cervical approach The anterolateral cervical approach is the most commonly used procedure, and its scope of application is as high as the third cervical vertebra (C3) and as low as the junction of cervicothoracic segments. For the C3 to C6 level, the authors tend to use the right cervical approach, while at the cervicothoracic junction, the authors tend to use the left cervical approach to avoid injury to the recurrent laryngeal nerve. The anterior approach to the upper sternum via the anterior approach to the upper sternal spine can be selected according to the need for surgery, choosing to split one or both sides in order to facilitate the surgical operation of low level segments, as low as the T4 segment. It also avoids the complications associated with total sternal splitting or clavicle osteotomy. Proficiency in these procedures will allow the spine surgeon to be more comfortable in the treatment of anterior spinal disorders. Although these approaches can also be used for anterior spinal decompression, anterior decompression often requires internal fixation, which is far less stable than posterior fixation. Because of this, when multisegmental internal fixation is required, combined anterior and posterior internal fixation of the cervical spine is often necessary to ensure the stability of the fixation. Therefore, for the cervical spine, although anterior surgery is important, it does not help the spine surgeon solve all the problems.