Cervical spondylosis is a common age-related degenerative disorder affecting the intervertebral discs, facet joints, ligaments, and vertebral bodies of the cervical spine. This process may result in axial neck pain, radiculopathy, and myelopathy, and surgical treatment is indicated in patients with progressive neurological deficits or refractory symptoms despite conservative management. Anterior cervical discectomy and fusion (ACDF) and its variants, such as corpectomy or cervical disc arthroplasty, are the most frequently used techniques for the surgical treatment of cervical spondylosis. The anterior approach provides direct access to the disc and osteophytes, allows restoration of sagittal balance, and is associated with high clinical success rates. Nevertheless, it carries a specific spectrum of complications related to the delicate anterior cervical anatomy and the instrumentation used, including esophageal perforation, recurrent laryngeal nerve injury, Horner syndrome due to sympathetic chain damage, vertebral or carotid artery injury, postoperative hematoma, infection, implant failure, pseudarthrosis, and adjacent segment disease. Recent systematic reviews and meta-analyses have demonstrated that, although major complications after anterior cervical surgery are rare, they are unavoidable and may be significantly reduced through careful preoperative risk stratification, meticulous surgical technique, and vigilant postoperative monitoring . In this chapter, complications associated with anterior cervical procedures for cervical spondylosis are reviewed under four main categories—injuries to adjacent anatomical structures, neural structures, surgical field–related complications, and instrumentation- or graft-related complications—separated into early and late presentations. Practical recommendations are provided regarding prevention, early diagnosis, and management algorithms to assist spine surgeons in daily clinical practice.