Anterior cervical decompressive surgery is widely performed for spondylosis, herniated intervertebral disk, tumor, infection, and trauma in the subaxial cervical spine region. Laceration of the vertebral artery is the most challenging of surgical dilemmas during anterior cervical spine surgery, as gaining control of the massive hemorrhage from a ruptured vertebral artery is difficult and could possibly result in an uncertain neurologic morbidity. As such, the understanding the surgical anatomy of the vertebral artery is essential to prevent iatrogenic injuries.