What it is
Decompression of the spinal cord and nerves through an incision at the back of the neck, combined with stabilization using screws and rods. It is the approach of choice where compression spans several levels, where it comes from behind, or where the neck is unstable or deformed.
Who it is for
Multi-level cervical myelopathy, compression from thickened ligament behind the cord, instability from trauma or inflammatory disease, and cases where a previous anterior operation has not resolved the problem. Alignment is a deciding factor: this operation works well in a neck that holds a normal curve and less well in one that does not.
How it works
Through a midline incision, the muscles are moved aside and the bony arch over the cord is removed or opened to create room. Screws are placed into the lateral masses or pedicles and connected with rods to hold alignment while fusion occurs. Bone graft is laid along the prepared surfaces.
Recovery
Usually two to three nights in hospital. Posterior neck soreness and stiffness are the main early complaints and settle over several weeks. Walking begins the day of or after surgery. Return to desk work is commonly three to six weeks; fusion consolidates over three to six months.
Risks and alternatives
Bleeding, infection — slightly more common than with anterior approaches — nerve or cord injury, screw malposition, failure of fusion, and persistent neck stiffness. Alternatives include an anterior approach, laminoplasty where motion can be preserved, or combined front-and-back surgery in more complex cases.