The posterior approach involves an incision along the midline of the back of the neck. Surgery may include cervical laminectomy or laminoplasty. These procedures are often also accompanied by spinal fusion.

The principal advantage of the posterior approach is that a spine fusion does not need to be done after removing the disc.

The principal disadvantage is that the disc space cannot be jacked open with a bone graft to give more space to the nerve root as it exits the spine. Also, since the posterior approach leaves most of the disc in place, there is a small chance (3% to 5%) that a disc herniation may recur in the future.

The objective of this procedure is to remove the lamina (and spinous process) to give the spinal cord more room.

The skin incision is in the midline of the back of the neck and is about 3 to 4 inches long. The para-spinal muscles are then elevated from multiple levels.

Removal of the lamina. A high speed burr can be used to make a trough in the lamina on both sides right before it joins the facet joint.

The lamina with the spinous process can then be removed as one piece (like a lobster tail). Removal of the lamina and spinous process allows the spinal cord to float backwards and gives it more room.

Instrumented Posterior Cervical Fusion

Incisional pain after posterior cervical spine surgery can be severe and very unpleasant to the patient. Ongoing incisional pain is one of the key disadvantages of posterior over anterior surgical approaches to the cervical spine. It prolongs hospital stays and delays return to work.

Patients who tolerated wearing the clavicle brace after posterior cervical spine surgery had reduced pain and used less pain medication ¹⁾.