The options for surgical treatment of injuries to the upper cervical spine have increased considerably in recent years. A distinction can be made between two forms of surgical stabilization. Techniques of osteosynthesis serve to reconstruct the injured structure with the goal of maintaining mobility of the upper cervical spine. A spondylodesis, that can be performed at the atlantoaxial or occipitoatlantoaxial joint, aims to stabilize the upper cervical spine by fusion techniques. This article describes the surgical procedures for both treatment principles with regard to the indications, techniques, and complications.