Decompressing and stabilising the neck from behind, with screws set into the columns of bone at the back of each vertebra and joined by rods. It is the operation for the neck that needs several levels dealt with at once, or that has become unstable, lost its curve, or failed to unite after surgery from the front.
There are two directions into the cervical spine, and each is better at different things. From the front, a surgeon can remove a disc or a vertebral body and take pressure directly off the cord — excellent at one or two levels. From behind, the whole back of the canal can be opened across many levels at once, and very strong fixation can be placed.
A posterior fusion uses that second direction for both jobs. The lamina is removed over the compressed levels so the cord has room, and screws are placed into the lateral masses — the blocks of bone where the joints stack up on either side — then linked with rods. The construct holds the neck in the position it has been set in while the bone fuses across.
Because the lamina has been removed, the levels have to be fused: taking the roof off without stabilising would leave the neck to drift into a forward curve over the following years. That is the trade this operation makes, and it is why laminoplasty exists as the alternative for necks that do not need stabilising.
Posterior cervical construct. Posterior and lateral views showing lateral mass screws and rods spanning several levels, with the laminae removed and the spinal cord decompressed behind.
Two of these deserve naming plainly, because they are the reasons most people arrive at this page. The first is a neck that needs three, four or five levels decompressed — a range where doing it all from the front becomes a long operation with a meaningful risk of failing to unite. The second is a fusion from the front that did not take; a posterior construct is much stronger fixation, and it approaches through tissue that has not been operated on.
This is the question behind most cervical operations, and it is decided by where the compression sits, how many levels are involved, and what the alignment is doing.
The row that does most of the work is the first one. A posterior operation does not remove compression sitting in front of the cord — it makes room behind and lets the cord fall back away from it. That works in a neck with a preserved forward curve and fails in a kyphotic one, which is why alignment has to be corrected as part of the operation where it has been lost.
Some necks need both, in one anaesthetic or in two stages. That is a considered plan for difficult anatomy rather than a sign something went wrong. See how the approach is chosen.
Both are posterior operations for multilevel cord compression, and the honest summary is short: fuse the neck that also has pain, instability or lost curve; hinge the lamina open on the neck that has none of those.
A fusion can correct alignment, treats instability, and reliably helps the axial neck pain that often accompanies multilevel degeneration. It costs the motion of the levels it spans. A laminoplasty keeps that motion and asks nothing of the bone to heal, but it cannot correct a curve, cannot stabilise, and does not treat neck pain.
Face down with the head held in a fixed clamp, the neck set in the alignment the construct is intended to hold. Spinal cord monitoring is running before the position is finalised, so that any change caused by positioning itself is seen at once.
A midline incision, with the muscle taken off the laminae over the levels being instrumented. The attachments at the top of the construct are protected where possible — they are part of what holds the head up afterwards.
Screws are placed into the lateral masses, and into pedicles at the levels where lateral masses are too small to hold — typically at the bottom of the neck and into the upper thoracic spine. Navigation is used where the anatomy warrants it; the vertebral artery runs close to these trajectories and its position is confirmed on the pre-operative imaging.
The laminae are removed across the compressed levels and the ligament beneath lifted off the cord. Foraminotomies are added where individual roots are pinched as well.
Rods contoured to the intended curve are seated into the screws and the neck is brought to that shape against them. This is the step that turns a decompression into a correction, and it is done gradually with monitoring watched throughout.
The exposed bone surfaces are roughened and graft is laid along them to fuse. Final imaging confirms screw position and alignment. The muscle is repaired in layers over the construct.
Posterior cervical decompression and fusion. Lateral mass screw trajectories, laminae removed across several levels with the cord decompressed, and the neck brought to its intended lordosis against contoured rods.
This operation has a characteristic recovery, and knowing its shape in advance makes it much easier to live through.
Figures are general ranges from the surgical literature, not guarantees for any individual case. Recovery varies with the number of levels fused, whether alignment was corrected, and general health. Smoking substantially reduces the chance the bone fuses. Follow the instructions you are given after your own operation rather than these.
How many levels are compressed, what your curve is doing on a standing X-ray, and whether a previous fusion has united are what decide this. Bring any imaging and any operative reports from previous neck surgery.