Posterior Cervical
Posterior Cervical Spine Surgery: Indications, Procedures, and Benefits
What is Posterior Cervical Spine Surgery?
Posterior cervical spine surgery is performed from the back of the neck to relieve pressure on the spinal cord and nerves or to stabilize the cervical spine. It is commonly used to treat conditions such as cervical myelopathy, spinal cord compression, fractures, tumors, and severe instability. Depending on the patient’s condition, the procedure may involve decompression, fusion, and instrumentation.
Indications for Posterior Cervical Surgery
1. Cervical Myelopathy with Multilevel Spinal Cord Compression
Multilevel cervical laminectomy is often preferred over anterior cervical decompression and fusion for patients with widespread spinal cord compression. This approach is:
- Less invasive and better tolerated in patients with existing medical conditions.
- Avoids the need for multilevel fusion, which is required in anterior procedures.
- Can be performed without fusion in selected cases, preserving motion.
2. Posterior Compression of the Spinal Cord
If the spinal cord is compressed from behind (with or without associated anterior compression), a posterior decompression is necessary to relieve symptoms.
Severe Cervical Instability
Patients with cervical spine fractures, spinal infections, or tumors often require posterior spinal instrumentation and fusion to restore stability. This procedure may be done in combination with anterior surgery.
Combined Anterior and Posterior Surgery
In complex cases, both anterior and posterior procedures may be needed to achieve complete decompression and stabilization. These surgeries can be performed:
- In a single session, or
- Staged over a few days based on the patient’s condition.
Advantages of Posterior Cervical Surgery
- Technically simpler than anterior surgery in certain cases.
- Effective for multilevel spinal cord compression without requiring extensive fusion.
- Preserves anterior structures, reducing the risk of complications such as damage to the esophagus or vocal cords.
Disadvantages and Limitations
- May lead to cervical kyphosis (forward bending of the neck) if not stabilized with fusion.
- Higher incidence of post-operative neck pain compared to anterior surgery.
- In some cases, anterior surgery may still be needed if anterior spinal cord compression persists.
Types of Posterior Cervical Surgery
1. Cervical Laminectomy
- Involves removing the lamina (the back part of the vertebra) at the compressed levels.
- Can be performed alone or in combination with fusion.
2. Cervical Laminectomy with Fusion
- Along with laminectomy, screws and rods are used to stabilize the spine.
- Prevents post-operative kyphosis and recurrence of symptoms.
- Recommended for patients with pre-existing instability.
3. Cervical Laminoplasty
- A motion-preserving procedure where the lamina is opened and repositioned like a door to expand the spinal canal.
- Advantages:
- Reduced post-operative neck pain.
- No loss of motion since fusion is not required.
- Maintains spinal stability without fusion.
- Limitations:
- Technically more complex than a standard laminectomy.
- May not provide enough decompression in severe cases.
- Auto-fusion may occur in some patients, reducing motion over time.
4. Posterior Cervical Micro-foraminotomy
- A minimally invasive procedure using a microscope or endoscope to remove a herniated disc fragment compressing a nerve.
- Best suited for radiculopathy (nerve pain radiating to the arms).
- Unlike anterior cervical discectomy, fusion is not required, allowing motion preservation at the operated level.
- Can be done with Endoscopic Spine Surgery technique also.
Conclusion
Posterior cervical spine surgery offers an effective treatment for conditions causing spinal cord and nerve compression, particularly in multilevel disease or instability cases. While it has many advantages, proper patient selection and surgical planning are crucial to achieving the best outcomes. In some cases, a combination of anterior and posterior approaches may be required for optimal results.
If you are experiencing neck pain, weakness, or signs of spinal cord compression, consult a spine specialist near you to determine the best surgical approach for your condition.
Frequently Asked Questions (FAQs) About Back Pain
Patients with multilevel spinal cord compression, spinal instability, or posterior cervical nerve compression are ideal candidates. A spine specialist will assess factors like symptoms, MRI findings, and medical history to determine the best approach.
Recovery varies based on the type of surgery and the patient's overall health. Typically:
- Laminectomy alone: 4-6 weeks for routine activities.
- Laminectomy with fusion: 8-12 weeks with restrictions on heavy lifting.
- Laminoplasty: 6-8 weeks with a focus on physical therapy.
Yes, physical therapy is crucial for regaining neck strength, improving flexibility, and preventing stiffness. Your surgeon will recommend a customized rehabilitation plan.
Potential risks include infection, bleeding, nerve injury, persistent neck pain, and post-surgical kyphosis. Choosing an experienced spine surgeon minimizes these risks.
It depends on the procedure:
- Laminoplasty preserves motion but may lead to minor stiffness.
- Fusion surgeries limit motion at the operated levels but prevent instability.
- Microforaminotomy allows full motion preservation.
Your surgeon will decide based on the location of compression, spinal alignment, and number of affected levels. Posterior surgery is preferred for multilevel posterior compression, while anterior surgery is better for isolated anterior compression.
If neck pain is due to nerve compression or instability, surgery can help. However, if pain is from muscle strain or arthritis, conservative treatments like physiotherapy may be better options.
