Who is a candidate?
Posterior decompression and fusion is considered for spinal cord compression across multiple levels, for instability from trauma or degeneration, for deformity requiring correction, and in revision situations. It is chosen over laminoplasty when the neck is unstable or the alignment is unfavorable, and over an anterior approach when compression is extensive or lies behind the cord.
How the procedure works
Through an incision at the back of the neck, the muscles are elevated to expose the posterior elements. The lamina is removed, or partially removed, to decompress the spinal cord. Screws are placed into the lateral masses or pedicles and connected with rods to stabilize the segments, and bone graft is laid over the prepared surfaces so the levels fuse over the following months.
Recovery
Walking begins the day after surgery in most cases. Posterior neck soreness is expected and is generally more pronounced than after an anterior approach, because the muscles are elevated. A collar may be used for a period. Myelopathic symptoms (balance, hand coordination) recover gradually and variably; the operation is often aimed at halting progression as much as reversing it.
Benefits and alternatives
The posterior route allows decompression across many levels in a single operation and provides strong stabilization where the spine needs it. Alternatives include laminoplasty where alignment allows and motion is worth preserving, anterior decompression and fusion for compression from the front, and combined approaches for complex cases.
Risks
Risks include infection, bleeding, nerve or spinal cord injury, C5 nerve palsy causing shoulder weakness, usually temporary, persistent posterior neck pain, hardware problems, and failure of the bone to fuse. Adjacent levels may degenerate under altered mechanics. Dr. Adapa reviews the risks specific to your anatomy before any decision.