The selection of the appropriate surgical approach in the management of an unstable cervical spine injury is predicated on the biomechanic deficiencies of the bony and ligamentous structures, the age of the patient, the level of experience of the surgeon, and the concomitant medical comorbidities. The optimal approach ideally is the least invasive, provides the greatest benefit-to-risk ratio in terms of potential injury to contiguous neurovascular structures, and provides adequate stabilization to avoid cumbersome external immobilization and allows early rehabilitation. This article discusses anterior, posterior, and combined stabilization techniques in patients who have sustained trauma to the upper and lower cervical spine.