Posterior Cervical Surgery
What is posterior cervical surgery?
Posterior cervical surgery is any procedure performed on the cervical spine in which the surgeon approaches the spine from the back (posterior) of the body. Cervical spine surgeries performed using a posterior approach include:
Posterior cervical discectomy
Posterior cervical discectomy is surgery to remove a herniated or diseased disc in the neck. It is performed to relieve pressure on the nerve roots or spinal cord and eliminate pain. The surgeon makes an incision in the back of the neck to reach the spine and remove the problematic disc. The major advantage of a posterior approach is that fusion is not needed. This preserves the normal motion of the cervical spine, and may shorten healing time.
Cervical discectomy often includes a laminotomy – the removal of a small piece of the lamina, the vertebral bone that makes up the roof of the spine. This is done to open up the spinal canal so the spinal nerves have more room. Extra bone spurs may be removed at the same time.
Posterior cervical decompression and fusion
Posterior cervical decompression and fusion is performed to relieve nerve pressure and pain caused by a herniated disc, spinal stenosis (a narrowing of the spinal canal) or spinal instability. An incision is made in the back of the neck, the problematic disc is removed, along with any bone spurs, and the vertebrae are fused together with a bone graft. Typically screws and a titanium plate are used to increase stability between the vertebrae. This procedure also may include a laminotomy – the removal of part of the lamina that is putting pressure on the spinal cord and nerve roots.
Posterior laminoplasty is performed to relieve nerve pressure and pain caused by spinal stenosis. In this procedure, the surgeon cuts into a small section of the lamina. One side is cut completely and the other is cut partially, enabling it to swing open like a door. It is then held open with titanium spacers or a bone graft and plates.
Posterior cervical laminectomy (with or without fusion)
Posterior cervical laminectomy is another type of procedure to relieve nerve pressure and pain caused by spinal stenosis. In this version, the surgeon removes the entire lamina. If one of the vertebrae has moved over another, or if there is curvature of the spine, spinal fusion may be needed for stability.
Posterior cervical laminoforaminotomy (with or without fusion)
Posterior cervical laminoforaminotomy is performed to relieve pressure and pain caused by foraminal stenosis – a narrowing of the space between the vertebrae where the nerve roots exit the spinal canal. In this procedure, the surgeon makes an incision in the back of the neck to reach the spine. The bone or disc fragment compressing the nerve root is removed, as well as the lamina. The surgeon also expands the opening of the foramen to give the nerve roots more room. Depending on the stability of the affected area, a fusion may be performed at the same time.
Who is a good candidate for posterior cervical surgery?
The type of spine surgery you have depends on many factors, including your age, overall health, previous surgeries, and the nature and severity of your condition. It is important that you are carefully screened by a qualified spine specialist to determine the best option for you.
The cervical spine is made up of the first seven vertebrae in the spine. These vertebrae protect the brain stem and the spinal cord, support the skull and allow for a wide range of head movement. Between each vertebra is a gel-like disc that acts as a shock absorber and provides a cushioning effect to absorb pressure and distribute stress. Facet joints link the vertebrae together and give them flexibility to move against each other. Small openings between the vertebrae, called foramen, provide space for the nerve roots to exit the spinal canal.
When is surgery recommended?
Surgery should always be the last resort when it comes to treating spinal conditions in the neck. Non-operative measures such as activity modification, non-steroidal anti-inflammatory medication, corticosteroids, epidural injections or physical therapy are often successful in alleviating symptoms. However, if these conservative measures do not work and you have worsening neck or back pain that limits your everyday activities, surgery may be necessary.
What is the recovery time?
Specific recovery time depends on the type of surgery performed. Minimally invasive surgical techniques are used to treat many spine disorders. Minimally invasive surgery offers a host of advantages for patients including less bleeding, tissue trauma and pain. As a result, patients generally recover and return to daily activities fairly quickly. However, minimally invasive surgery is not always the best option for every spine condition or every patient. Evaluation by a qualified surgeon is important to select the treatment best suited to an individual’s diagnosis and general health.