What it is
Posterior cervical fusion stabilizes the cervical spine from behind using screws placed into the lateral masses or pedicles of each vertebra, connected by rods. Bone graft is placed along the posterior elements to promote fusion across the instrumented levels. When performed in conjunction with laminectomy, it provides decompression (from laminectomy) and stability (from instrumentation and fusion).
When it's needed
Not every posterior cervical procedure requires fusion. Laminoplasty, for example, decompresses without instrumented fusion. Posterior fusion is added when:
- The cervical spine lacks adequate lordosis (straight or kyphotic alignment), making laminoplasty less effective
- Decompression would create instability without fixation
- Deformity correction requires fixation to maintain the corrected position
- Prior anterior constructs need posterior augmentation for complete deformity correction or instability
Extent of fusion
One of the important decisions in posterior cervical surgery is how many levels to include in the fusion. Longer fusions are more stable but transfer more mechanical stress to the ends of the construct and limit motion. The goal is to include what is necessary — and no more.
What to expect
Posterior cervical fusion is a larger procedure than anterior single-level surgery. Hospital stay is typically two to three nights. A cervical collar is often worn for a period after surgery. Recovery is measured in weeks to months, and fusion maturation (confirmed on imaging) takes several months. Most patients with myelopathy notice gradual improvement in neurological function that continues for up to a year.