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Posterior cervical decompression with instrumentation and fusion is a surgical procedure that relieves spinal cord compression by removing bone and thickened ligaments from the back of the spinal canal. This approach is used when compression comes primarily from structures behind the spinal cord, such as hypertrophic ligamentum flavum, posterior bone spurs, or when multi-level decompression is needed. Dr. Thomas M. Wascher has performed 1,070+ posterior cervical procedures over 33+ years with a complication rate of 1.9% requiring repeat surgery, significantly lower than national averages.
Posterior decompression creates more space for the spinal cord by removing the lamina (roof of the spinal canal) and any thickened ligaments or bone spurs compressing the cord from behind. The procedure is combined with instrumentation (screws and rods) and fusion to maintain spinal stability after decompression. This approach is particularly effective for patients with multi-level stenosis, those who have had previous anterior surgery, or when compression comes primarily from posterior structures.
Posterior Decompression Complication Rate:
Dr. Wascher: 1.9%
(Complications requiring repeat surgery)
Significantly lower than national averages
1,070+ Posterior Cervical Procedures
33+ Years of Data
(September 1992 - December 2025)
Comprehensive treatment for multi-level stenosis and myelopathy
Nanette: Posterior Laminectomy with Fusion
Multi-level stenosis causing severe myelopathy
Complete decompression and stabilization
Neurological recovery and return to activities
Successful fusion and pain relief
Posterior cervical decompression is recommended when spinal cord compression comes from structures behind the spinal cord and cannot be adequately addressed through an anterior approach. Common conditions requiring posterior decompression include:
Cervical Stenosis: When multi-level narrowing of the spinal canal causes compression from thickened posterior ligaments (ligamentum flavum) or posterior bone spurs, posterior decompression addresses all levels through a single approach. This is particularly effective when stenosis involves three or more levels.
Cervical Myelopathy: When spinal cord compression from posterior structures causes progressive hand clumsiness, gait difficulty, balance problems, and loss of fine motor control, posterior decompression prevents further neurological decline and allows spinal cord recovery. Myelopathy from posterior compression requires urgent surgical intervention.
Multi-Level Compression: When spinal cord compression involves multiple consecutive levels, posterior decompression can address all levels simultaneously rather than requiring multiple anterior approaches. This provides comprehensive decompression through a single posterior incision.
Previous Anterior Surgery: When patients have had previous anterior cervical surgery and require additional decompression, a posterior approach avoids scar tissue and complications from repeated anterior dissection. This is safer than multiple anterior procedures in the same area.
Ossification of Posterior Longitudinal Ligament (OPLL): In some cases of OPLL, a posterior decompression approach provides indirect decompression by creating more space behind the spinal cord, allowing the cord to drift backward away from anterior compression. This may be combined with anterior corpectomy for severe cases.
Upper Cervical Stenosis (C2-C4): For stenosis at high cervical levels, posterior decompression is often preferred over anterior approaches in patients over age 65, as high anterior surgery carries increased swallowing complications in older patients.
Dr. Wascher evaluates each patient with advanced imaging (MRI, CT scans) and thorough neurological examination to determine if posterior decompression is the most appropriate surgical approach. Learn more about surgical decision-making for cervical spine disease.
Posterior cervical decompression is performed through a vertical midline incision at the back of the neck. Dr. Wascher carefully dissects the muscles away from the spine to expose the lamina (roof of the spinal canal) at the affected levels.
Using specialized instruments and microsurgical technique, Dr. Wascher removes the lamina and spinous processes to open the spinal canal from behind. The thickened ligamentum flavum (yellow ligament) is removed, and any bone spurs compressing the spinal cord are carefully addressed. This creates immediate space for the spinal cord to decompress and drift backward away from anterior compression.
Once decompression is complete, instrumentation and fusion are performed to maintain spinal stability. Titanium screws are placed into the lateral masses (bony pillars on either side of the spinal canal) at each level, and rods connect the screws to create a stable construct. Bone graft material is placed along the fusion bed to promote solid bone healing between the vertebrae.
The instrumentation provides immediate stability while the bone graft heals into a solid fusion mass over several months. Without instrumentation and fusion, laminectomy alone can lead to progressive kyphosis (abnormal forward curvature) and instability, which is why fusion is essential for optimal long-term results.
The entire procedure is performed under general anesthesia with intraoperative neuromonitoring to continuously assess spinal cord and nerve root function throughout the surgery. Most posterior procedures require a brief hospital stay for monitoring and pain management.
Most patients experience gradual improvement in myelopathic symptoms as spinal cord compression is eliminated. Improvement in hand function, gait, and coordination occurs over several weeks to months as the spinal cord recovers from chronic compression. Neck pain from muscle dissection is typically more significant initially compared to anterior approaches but improves steadily with healing.
Patients typically wear a cervical collar during the initial healing phase to protect the fusion while bone develops. Physical therapy begins once adequate healing has occurred, focusing on restoring neck strength, range of motion, and proper posture.
Return to work and activities varies by patient and the extent of surgery performed. Multi-level posterior fusion requires longer recovery than single or two-level procedures. Dr. Wascher provides detailed post-operative instructions and maintains close follow-up to ensure optimal healing.
Fusion success rates are high with modern instrumentation techniques. Follow-up X-rays or CT scans confirm solid bone healing across the fusion construct. While fusion eliminates some neck motion, most patients maintain functional neck mobility and achieve stable, pain-free necks with significant neurological improvement.
Vanessa had years of neck pain leaving her unable to even do her daily work. But with Dr. Wascher’s quick and timely intervention that included multiple viewings of MRIs, muscle and nerve tests, followed by a 3-Level Anterior Cervical Fusion, she is now happy without any neck issues. “I can happily say that by following the recommendations of Dr. Wascher, I am now pain-free,” says Vanessa as she talks about how great Dr. Wascher and his team were to work with.
When Nanette experienced deep pain in her shoulder, she got tests performed, only to discover that she, in fact, had issues with her neck instead. After a few MRIs and scans, she contacted Dr. Wascher, who told her that she has bone spurs going into the spinal cord. Within a span of 3 weeks, she was able to go through surgery and get on the road to recovery. “I cannot say enough about Dr. Wascher’s expertise and empathy”, says Nanette as she joins an ever-growing community of people who, through Dr. Wascher and his team, have found happiness again.
Dr. Thomas M. Wascher is one of the few cervical spine specialists in the country who focuses exclusively on the cervical spine, bringing unmatched expertise to both anterior and posterior decompression approaches. With 1,070+ posterior cervical procedures performed over 33+ years, he has achieved complication rates significantly lower than national averages. Dr. Wascher was valedictorian of his high school, college, and medical school classes and has been named to America's Top Surgeons since 2007 and Best Doctors in America since 2000.
Dr. Wascher carefully evaluates each patient to determine the optimal surgical approach, whether anterior, posterior, or combined. His philosophy is simple: treat every patient as a family member with a unique approach tailored to their specific condition, anatomy, and goals. He takes the time to explain why a particular approach is recommended and ensures patients understand all options before proceeding.
Anterior cervical decompression approaches from the front of the neck to remove discs, bone spurs, and ligaments compressing the spinal cord from the front. Posterior decompression approaches from the back of the neck to remove bone and ligaments compressing the spinal cord from behind. The choice depends on where the compression is located, how many levels are involved, and other patient-specific factors.
Removing the lamina (laminectomy) eliminates the posterior support structures of the spine. Without fusion and instrumentation, the spine can develop progressive kyphosis (forward curvature) and instability, leading to recurrent symptoms and neurological problems. Fusion with instrumentation maintains proper alignment and prevents these complications.
Dr. Wascher achieves excellent results with posterior decompression, with complication rates of 1.9% requiring repeat surgery, significantly lower than national averages. Most patients experience significant neurological improvement as spinal cord compression is relieved, though recovery may be more gradual compared to anterior approaches.