Posterior Cervical Decompression and Fusion Guidelines

Clinical Indications

The American Association of Neurological Surgeons recommends posterior cervical decompression and fusion for patients with progressive cervical myelopathy, severe stenosis, and prior anterior fusion, as it provides significant neurological improvement and prevents late deterioration 1, 2, 3
Patients with worsening symptoms despite prior surgery require additional decompression, and surgical intervention should not be delayed, as outcomes are superior when symptoms have been present for less than one year 3, 6, 4, 5

The posterior approach is specifically indicated in clinical scenarios with prior anterior cervical fusion, as it allows for multilevel stenosis treatment and prevents late deterioration 1, 2
Laminectomy with fusion demonstrates significantly better neurological recovery than laminectomy alone, with improvement of 2.0 Nurick grades versus 0.9 for laminectomy alone 1, 3

60-80% of patients demonstrate neurological improvement after posterior decompression and fusion for cervical myelopathy, with complete bony fusion occurring in 97-100% of patients when instrumentation is combined with bone graft 1, 3
Posterior fusion with instrumentation maintains cervical alignment and prevents progressive kyphosis, with a significant reduction in pseudarthrosis and late deterioration rates 1, 2, 3

The patient's progressive symptoms indicate evolving myelopathy that requires urgent intervention to prevent permanent neurological damage, and prior anterior fusion does not preclude posterior surgery 4, 5, 6
Inpatient level of care is appropriate given the complexity of multilevel posterior fusion with instrumentation and the need for postoperative neurological monitoring 3