Neck and arm pain is one of the leading diseases with high prevalence. Etiology may differ from trauma to infections and tumors of the cervical spine. The pathologies other than degenerative diseases all deserve different approaches in terms of diagnosis, management and micro-neurosurgery and are not in the scope of this review. Although micro-neurosurgical decompression is not the first and only solution for most cases, it should be considered as the approach with acute and robust outcome for the selected patients who present no response to non-surgical therapies. Surgical approach should be tailored to every other case regarding the patient and the degenerative pathology as well as the surgical team, its experience and technical availabilities.