Posterior cervical fusion is an operation to stabilise the cervical spine from the back of the neck using screws and rods. It is performed for instability, fractures, deformity, and multi-level degenerative disease where a posterior approach is preferred.
A midline incision is made at the back of the neck. The muscles are retracted. Lateral mass screws or pedicle screws are placed into the cervical vertebrae. Rods are connected to the screws to provide stability. Bone graft (local bone, allograft, or synthetic) is placed along the fusion bed. Decompression (laminectomy) may be performed at the same time. The operation takes two to three hours.
Posterior cervical fusion is recommended for cervical fractures and dislocations, failed anterior cervical fusion, multi-level cervical instability, cervical deformity (kyphosis), rheumatoid cervical instability, and as a supplement to anterior surgery in revision or complex cases.
Cervical collar or halo vest for certain fractures. ACDF for single or two-level anterior pathology. Observation for stable conditions.
CT and MRI for screw trajectory planning. Assessment of vertebral artery position. Standard pre-assessment.
Reliable stabilisation of the cervical spine. High fusion rates. Effective for conditions not amenable to anterior surgery alone.
Muscle dissection causes significant post-operative neck and shoulder pain.
The fused levels do not move.
More than anterior cervical procedures.
Risk approximately 1%.
Risk from screw placement near the artery. Very rare with careful technique.
May irritate nerve roots.
Deltoid weakness after decompression.
Wound or deep infection approximately 2–3%.
Long-term stress on adjacent levels.
Failure of fusion.
General anaesthesia with neuromonitoring. Prone or sitting position. Careful neck positioning is critical.
Hospital stay two to five days. Rigid cervical collar for six to twelve weeks. Return to desk work at four to eight weeks. Avoid heavy lifting for three months. Full fusion at three to six months.
X-rays at six weeks, three months, and six months. CT scan if fusion is uncertain.
The posterior approach is preferred for multi-level decompression, fracture-dislocations, posterior ligament injuries, and cases where anterior surgery alone is insufficient. Many conditions benefit from a combined anterior-posterior approach.