Posterior Cervical Decompression

Cervical myelopathy develops when the spinal canal in the neck becomes narrowed — by age-related changes, bone spurs, thickened ligaments, or a congenitally narrow canal — and the spinal cord is compressed. This can cause clumsiness of the hands, problems with balance and walking, and other changes. When the compression involves several levels and comes substantially from behind, or where the neck alignment favours a posterior approach, decompressing the cord from the back can be considered to protect and improve function.

Posterior cervical decompression is carried out through an incision at the back of the neck. Pressure on the cord is relieved by removing part or all of the bony arches (laminectomy) and any thickened ligament pressing on the cord, opening up the canal. Depending on the situation, this may be combined with a fusion to maintain stability and alignment, or performed as a laminoplasty, which reconstructs the canal to keep it open while preserving more of the bony architecture. The specific technique is chosen to suit the pattern of compression and the alignment of the neck.

This operation can be considered for cervical myelopathy from multilevel compression, especially where the narrowing comes largely from behind, where several levels are involved, or where the neck alignment is favourable. It is often preferred over an anterior approach when many levels need decompressing. The choice between decompression alone, decompression with fusion, and laminoplasty depends on the number of levels, the alignment and stability of the neck, and the individual — and is weighed carefully, since maintaining good alignment is important to a lasting result.

The evidence supports surgical decompression for cervical myelopathy. Large prospective studies show that decompression can halt progression and produce meaningful improvement in function and quality of life, and comparative reviews examine posterior decompression against anterior surgery, and laminectomy with fusion against laminoplasty, to guide the choice for different patterns. A recognised consideration with posterior decompression alone is maintaining alignment, which is why fusion or laminoplasty is often used. The balanced view is that posterior decompression is an effective, well-evidenced treatment for suitable multilevel myelopathy, with the specific technique tailored to the individual.

The operation is performed under general anaesthetic, usually with a hospital stay of a few days. The main goal is to protect the spinal cord and give it room to recover; improvement in hand function, balance and walking can occur gradually over months, though the degree varies with how long and how severe the compression has been. Rehabilitation supports recovery. As with any operation there are risks, which are discussed fully beforehand. The best approach for a given person is decided together.

• —Fehlings MG, et al. Efficacy and safety of surgical decompression in cervical spondylotic myelopathy: AOSpine North America prospective multicentre study. J Bone Joint Surg Am 2013. (PMID 24048552)
• —Sattari SA, et al. ACDF versus posterior decompression in degenerative cervical myelopathy: systematic review and meta-analysis. J Neurosurg Spine 2023. (PMID 36840737)
• —Avetisian H, et al. Laminoplasty versus laminectomy and posterior fusion for cervical myelopathy: meta-analysis of radiographic and clinical outcomes. Global Spine J 2024. (PMID 38764362)
• —Yuan W, et al. Laminectomy and fusion versus laminoplasty for multilevel cervical myelopathy: systematic review and meta-analysis. Eur Spine J 2017. (PMID 27342611)