STUDY DESIGN: Retrospective Survey Analysis. OBJECTIVE: To explore surgeon preference in the choice of surgical approach in the treatment of traumatic cervical facet dislocations. SUMMARY OF BACKGROUND DATA: The choice of surgical approach in the treatment of traumatic cervical dislocations is highly variable and maybe influenced by a variety of factors. The purpose of this study was to examine inter-rater reliability in choice of surgical approach. METHODS: Twenty-five members of the Spine Trauma Study Group evaluated 10 cases of traumatic cervical dislocations. Evaluation of the case as a unilateral or bilateral injury and surgeon interpretation of the presence of a disc herniation as well as preferred surgical approach were assessed. RESULTS: Only slight agreement was observed among surgeons in the choice of surgical approach (Kappa < 0.1). This improved slightly when patients were assumed to have a complete spinal cord injury (Kappa = 0.15). Surgeons used more anterior approaches either alone or as the first stage in a combined approach when a disc herniation was present regardless of neurologic status of the patient. When a patient was neurologically intact, an anterior approach was more common than a posterior approach even when a disc herniation was not present. Combined approaches were preferred for the treatment of bilateral facet dislocations. CONCLUSION: The poor agreement on the treatment of these injuries likely reflects a combination of factors including surgeon training and experience. Treatment decisions are likely to be affected by the neurologic status of the patient, interpretation of a disc herniation, and the classification of the injury as a unilateral or bilateral injury.