Posterior Cervical Fusion

What Is Posterior Cervical Decompression & Fusion?

Posterior cervical fusion is performed through an incision on the back of the neck to stabilize and fuse one or more cervical vertebrae. This approach allows decompression over a wider area than an anterior approach and is preferred for multilevel disease, instability requiring robust fixation, or revision surgery. Lateral mass or pedicle screws, connecting rods, and bone graft create a stable fused construct. A laminectomy to decompress the spinal cord is often performed at the same time. Surgery typically lasts 2–4 hours under general anesthesia. Intraoperative neurophysiologic monitoring (IONM) is used throughout.

Common Indications

• Multilevel cervical stenosis with myelopathy (spinal cord compression)
• Cervical instability from trauma, rheumatoid arthritis, or prior surgery
• Failed ACDF with persistent instability or failed fusion (pseudarthrosis)
• Ossification of the posterior longitudinal ligament (OPLL)
• High cervical pathology not accessible from an anterior approach

Posterior cervical fusion with laminectomy achieves neurological improvement rates of 70–95% in multilevel myelopathy, with significant improvement in patient-reported outcomes and a 98% pooled fusion rate across 31 studies and 1,238 patients (Foresti et al., Spine J 2019).

Alternatives to Surgery

Surgery is one option for managing your condition. Not all alternatives are appropriate for every patient — their suitability depends on your specific diagnosis, symptoms, and prior treatment history.

• Anterior cervical approach (ACDF) — an alternative surgical option for some anatomies and pathologies
• Cervical immobilization with a collar
• Physical therapy — cervical strengthening and postural training
• Chiropractic care
• Epidural steroid injections or selective cervical nerve root blocks
• Oral medications — anti-inflammatory agents, neuropathic pain medications
• Observation — for mild or neurologically stable myelopathy with close monitoring
• No surgery — with understanding that cord compression may progress

Choosing not to have surgery is always an option. Your surgeon has discussed what you can expect if you decide not to proceed, including the possibility that symptoms may persist, worsen, or in some cases improve without surgery.

What Happens During Surgery

1. You are positioned face-down in a specialized head-holder to protect the neck and optimize surgical access. Neuromonitoring leads are applied to track spinal cord and nerve function throughout.
2. A midline incision is made along the back of the neck. Muscles are elevated from the posterior spine on both sides to expose the surgical levels.
3. Lateral mass screws (or pedicle screws at C2/C7 and below) are placed bilaterally at each level to be fused.
4. Laminectomy is performed if decompression is needed — removing the laminae at compressed levels to relieve pressure on the spinal cord.
5. Connecting rods are shaped to match normal cervical lordosis and secured to the screws.
6. Bone graft — including autologous bone from the surgical site, allograft (cadaver bone), or biologic bone-forming agents — is placed over the prepared bone surfaces to promote fusion.
7. The wound is closed in layers. Drains are placed as needed and typically removed within 24–48 hours.

Risks of Surgery

General Surgical Risks

• Infection or wound dehiscence — risk is higher than anterior approaches and could require reconstructive procedure; also epidural abscess, meningitis
• Bleeding or blood transfusion
• Blood clots (DVT or pulmonary embolism)
• Stroke
• Heart attack
• Paralysis
• Death
• Adverse anesthesia reaction
• Pneumonia or urinary tract infection
• Corneal abrasion or blindness
• Ulnar nerve, median nerve, or brachial plexus injury from positioning
• Unforeseen metal allergy
• Additional surgery for any noted or unforeseen complications

Procedure-Specific Risks

• C5 palsy — shoulder and deltoid weakness, usually resolves over weeks to months but could be permanent
• Nerve root and/or spinal cord injury — sensory changes, weakness, or paralysis (temporary or permanent)
• Hardware failure — screw or rod breakage, rod slippage, screw loosening or malposition
• Failed fusion (pseudarthrosis)
• Adjacent segment disease
• Post-laminectomy kyphosis
• Significant axial neck pain
• Wrong level
• Bone fracture
• Vertebral artery injury
• Loss of bowel, bladder, or sexual function
• Permanent hoarseness or voice change (less common than anterior approach)
• Hardware prominence or pain — may require hardware removal
• Symptoms may be unchanged, worse, new, or different after surgery

Your Hospital Stay

Typically 1–3 nights. Complex or multilevel cases may require longer. ICU or step-down observation is commonly used the first night.

Recovery at Home

Activity Timeline

• Weeks 1–2: Rest, short walks, no driving on opioids. Limit neck movement per surgeon's instructions. No lifting more than 10 lbs.
• Weeks 2–4: Gradually increase activity. Desk work with breaks if pain is controlled.
• Weeks 4–8: Activity increased with surgeon guidance at your 1-month visit.
• Months 2–3: Return to most light activities. No contact sports until fusion is confirmed.
• Months 3–6+: Full activity return based on imaging and clinical assessment.

Return to Work — Typical Timelines

All timelines are estimates. Your surgeon will provide formal work release at follow-up based on your progress.

Wound Care

• Keep the incision clean and dry for the first 48–72 hours after discharge.
• You may shower after 48 hours — allow water to run gently over the area. Do not scrub.
• Do not submerge in a bathtub, pool, or hot tub until cleared by your surgeon (typically 4–6 weeks).
• Steri-strips should fall off on their own over 7–10 days. Do not remove them.
• Dissolvable sutures do not need removal. External sutures or staples are removed at your 2-week visit.
• Monitor for signs of infection and call our office promptly if you have concerns.

Medications at Discharge

• Opioid pain medication — Use only as needed for pain not controlled by other measures. Do not drive, operate machinery, or consume alcohol while taking opioids. Short-term use only (1–2 weeks typical).
• Muscle relaxer — Helps reduce painful muscle spasm. May cause drowsiness.
• Stool softener (docusate) — Take while using opioids to prevent constipation. Drink 6–8 glasses of water daily.
• Acetaminophen (Tylenol) — Do not exceed 3,000 mg/day. Do not take additional Tylenol-containing products concurrently.

Opioids are for short-term use only — typically 1–2 weeks. Taper as pain allows. Do not request early refills. Dispose of unused medication safely at a pharmacy take-back program.

Follow-Up Schedule

Warning Signs

For urgent concerns outside of office hours, call (405) 748-3300 — our answering service is available 24 hours a day, 7 days a week.