Cervical Spine
Posterior Cervical Fusion with Decompression
Posterior approach for multi-level cervical myelopathy or instability. Decompress the cord and fuse the segment in one operation.
What it is
Posterior cervical fusion with decompression addresses the spinal cord from behind the neck. The lamina at the affected levels is removed (laminectomy), the cord is given room, and lateral mass screws connected by rods stabilize the segment. Bone graft is placed to promote long-term fusion.
For multi-level disease — three or more levels — and for cases where the cord compression comes primarily from behind (ossified ligament, congenital narrowing), the posterior approach is often the right answer.
Why this procedure when surgery is needed
For multi-level cervical myelopathy, especially when the cervical spine is straight or kyphotic, posterior decompression with fusion gives reliable cord relief and structural stability. Anterior multi-level approaches are technically demanding and carry higher complication rates beyond two levels.
When the alignment of your cervical spine is already favorable (lordotic), laminoplasty — a motion-preserving variation that opens the canal without fusing — may be the right alternative. We discuss this carefully before any decision.
What to expect
Surgery typically takes 3–4 hours.
Hospital stay of 1–3 nights.
Some neck stiffness is expected as a trade-off for the fusion.
A soft collar may be worn for comfort the first 1–2 weeks.
Return to desk work in 4–6 weeks; full activity at 3 months.
Goal is to halt myelopathy progression and give the cord space to recover.
Approach
- Posterior midline approach with operating microscope
- Multi-level laminectomy with foraminotomy as needed
- Lateral mass or pedicle screws and rod stabilization
- Intraoperative neuromonitoring throughout
- Multimodal pain control protocol
Typical indications
- Multi-level cervical myelopathy (3+ levels)
- Cervical kyphosis or instability with cord compression
- Ossified posterior longitudinal ligament (OPLL)
- Failed prior anterior surgery requiring revision
- Cervical deformity correction
Alternatives we considered
- Anterior multi-level ACDF (for select cases, typically 2 levels)
- Cervical laminoplasty (motion-preserving, when alignment permits)
- Combined anterior-posterior approach in complex cases
- Continued observation with documented cord injury at risk of progression
Last reviewed: 2026-05-10· Author: Chad Tuchek, MD · Cotton O'Neil Neurosurgery and Spine Center, Stormont Vail Health
The information on this page is general patient education and is not a substitute for individualized medical advice. For urgent symptoms, call 911 or go to the nearest emergency department. For non-urgent questions, call (785) 368-0767.