The cervical spondylotic myelopathy is the most frequent spinal dysfunction. Its spontaneous course is very variable, from progress to stagnation. This makes prognosis and decision-making difficult for conservative or operative treatment. The authors attempt to provide some basis for decision-making by observing the individual course of neural dysfunction, consideration of morphometric data and the use of functional scores. To advise a patient, the outcome of conservative and operative treatment as described in the literature has to be considered, as well as the possible complications. The advantages and disadvantages of surgery from the anterior and posterior approach are discussed. Operative planning according to the individual condition is suggested. Operative techniques of anterior decompression and fusion are contrasted to laminoplasties.