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Review of surgical technique.To provide accounts of the authors' preferred methods for performing anterior cervical surgery with personal tips and pearls.Many have described the various anterior surgical approaches to the cervical spine, and in this review, we hope to describe our preferences, highlighted with some tips and pearls.Various accounts of the transoral, the anterolateral (Smith-Robinson), and the split manubrium approaches were reviewed and used as the basis of the review. Additional notes with regard to the authors' preferences were noted to provide further guidance. The descriptions were delineated from the most cephalad to the most caudal.The transoral, the anterolateral (Smith-Robinson), and the manubriotomy approaches were described. Each account starts with the basic preoperative considerations, then describes the incision and the main anatomical landmarks, and finally concludes with closure and main complications to monitor for. A brief description of the main pathologies that each approach may address is also provided.The 3 anterior approaches to the cervical spine are direct and elegant solutions to pathologies arising from the anterior column. They supplement the more commonly used posterior approaches, which provide stronger multilevel fixation, and thus provide an essential tool in the armamentarium of spine surgeons.