Summary Pathologic conditions of the cervical vertebral column cause combinations of pain, neurologic deficits and behavioural issues that affect welfare and performance in the horse. A diagnosis of cervical vertebral malformation (CVSM) is associated with a high mortality rate, especially when identified in young animals. Surgical treatment offers the potential for long term improvement or resolution of clinical signs, at the cost of the potential for complications and an initial increased financial outlay. There are difficulties with extrapolating published outcomes to the individual case, however representative reported outcomes following cervical vertebral interbody fusion are an improvement in ataxia of 1 grade in 60-86% of horses, 2 grades in 7-74% of horses and 3 grades in 1-13% of horses, with a fatal complication rate of 6-18%. Multiple factors such as lesion location, cause of stenosis and duration of compression affect surgical outcome. Case selection should take into account factors such as severity of initial presentation, temperament, intended use and owner attitudes. Uniportal endoscopic foraminotomy is in its infancy but shows great promise as a minimally invasive procedure able to relieve clinical signs associated with spinal nerve impingement in the cervical vertebral column. This condition is being increasingly recognised, particularly in Warmblood sport horses. Details of greater case numbers and longer term follow up is required but around 87% of the first operated cases have shown significant improvement in signs. Cervical articular process joint arthroscopy/arthrotomy is uncommonly indicated but offers a low risk and successful treatment option for horses diagnosed with clinically relevant and surgically accessible intra-articular fragments or loose bodies within these joints.