Regardless of the approach to the cervical spine, it is clear that surgical outcome is directly related to surgical technique. Posterior decompressions must be thorough and complete because laminoforaminotomies provide an excellent means of decompressing foraminal pathology. One of the distinct advantages of posterior laminoforaminotomy is that it offers direct visualization, exposure, and decompression of the nerve root without performing a fusion. A posterior laminoforaminotomy is the preferred approach for patients with a soft lateral disk herniation, for those at increased risk for nonunion, or those for whom an anterior procedure would not be optimal. To perform a thorough decompression and prevent iatrogenic instability and neurologic deficits, however, surgeons must be familiar with the anatomy of the foramen as well as the compressive pathology. Several issues must be addressed before performing a posterior laminoforaminotomy, namely, the absence of instability and junctional kyphosis, and the proper identification of the offending pathology.