Cervical spondylosis is a problem usually starting in middle age with progressive changes in the cervical discs. The degeneration leads to motion abnormalities, loss of disc length and disc arthrosis in the vertebral and facet joint. The disc degeneration and arthrosis in joint with super formation can cause compression of the spinal cord from the front and fact arthrosis and ligament redundancy can cause compression of the spinal cord from the back 1-3. This circumferential compression due to spondylosis leads to spinal canal narrowing and static impingement on the spinal cord. In addition, there is a dynamic component of spinal cord compression, an extension of the cervical spin can cause buckling of the ligamentum flavum and flexion can cause disc bulging. The indication for surgical approach need to be tailored to the patients based on the function, symptoms rates decline and medical status. For patients with moderate to seven disability at presentation, it is unlikely that significant serve improvement will occur. AIM OF THE WORK: A retrospective study will be done with a trial to reach to reach a conclusion about the surgical decision making in managing these cases and the validity of each surgical approach and technique for each case. MATERIAL AND METHODS: Twenty cases will be included in this study. The clinical Presentation, imaging and all diagnostic work up were retrospectively analyzed. Regarding surgical approach that was used, the results are reviewed for each surgical approach and technique.