Cervical spine surgery has been performed for more than a century. As the indications for surgery changed over the years, so did the surgical technique and technology that is being used. I will present the original indications and surgical solutions from around 1911, heading degenerative disease of the spine to address contemporary cervical disc surgery and end with a glimpse of what is coming towards us. The total cost of these operations is increasing year after year: more patients are being treated, patient age is no longer an exclusion; the price of implants is rising because of the evolution towards cervical disc prosthesis instead of fusion with cages and plates. The exponential rise in cost might create a shift back to non-instrumented minimally invasive surgeries.As more levels are being treated, either as a planned single surgery or as a second or third surgery on the cervical spine over time, to address further degeneration and adjacent segment disease, it might be wise to study the sagittal alignment of the cervical spine, in comparison to the lumbar spine. The presentation will end with an overview of the armamentarium the spine surgeon has at his disposal and summarizing the different treatment options.