Since its introduction in 1955, anterior cervical disk surgery has become widely accepted as an effective treatment for degenerative disk disease and spondylosis. Modifications to the original procedure have included the use of different grant constructs, the omission of bone grafting, posterior and posterolateral osteophyte removal, and the addition of internal fixation. Although satisfactory relief of symptoms has been reported in up to 90% of patients treated with anterior decompression, a subset of patients fails to improve from this intervention. Failure of anterior cervical disk surgery and revision surgery can be classified as improper diagnosis, inadequate decompression, failure of the graft construct, pseudarthrosis, complications of internal fixation, and accelerated degeneration at adjacent segments. This manuscript reviews these causes of failure in light of the new approaches being taken to improve the success of these procedures.