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Cervical spineMinimally invasive surgery

Posterior cervical fusion (instrumentation with lateral mass or cervical pedicle screws)

Posterior cervical fusion (instrumentation with lateral mass or cervical pedicle screws) is considered for patients with chronic neck pain, stiffness and often arm radiation or difficulty walking and balancing. Most have tried medication, physiotherapy or other conservative measures without sufficient improvement and imaging shows instability, deformity or posterior compression. The procedure decompresses the cord and nerve roots and stabilises multiple levels from the back of the neck using screws, rods and bone graft, providing strong fixation. Indication is personalised, based on symptoms, neurological exam and MRI/CT to protect neurological function and slow progression.

Spine neurosurgeon in Alicante and Benidorm
More than 20 years of experience in Neurosurgery (since 2003)
Vithas Medimar Hospital Alicante and Hospital Clínica Benidorm
Medical illustration of posterior cervical fusion with screws and rods.

What is Posterior cervical fusion?

Posterior cervical fusion is a stabilisation procedure performed from the back of the neck. Screws are placed in the lateral masses or pedicles, connected with rods, and bone graft is added to achieve solid fusion, correcting or preventing instability and protecting the cord and roots. It also allows wide posterior decompressions such as laminectomy or foraminotomy when needed.

Symptoms and warning signs

Watch for:

Persistent neck pain with stiffness and possible radiation to shoulders and upper back
Pain radiating to one or both arms with tingling or numbness in hands and fingers
Hand clumsiness, difficulty buttoning clothes, writing or handling small objects
Unsteady gait, feeling stiff or insecure when walking, tendency to trip
Red flags: progressive or sudden loss of strength in arms or legs, frequent falls, bowel or bladder disturbances or rapid gait worsening needing urgent assessment

When is this procedure indicated?

Persistent neck, radicular or myelopathic symptoms despite conservative care
MRI or CT showing posterior cervical stenosis, cord or root compression and/or deformity (kyphosis, instability) warranting a posterior approach
Neurological progression: worsening gait, falls, increasing hand clumsiness or loss of strength
Disabling pain limiting quality of life, independence and work capacity
Documented cervical instability (traumatic, degenerative or postsurgical) requiring multilevel fixation

How is the procedure performed?

1.Preoperative preparation

A detailed neurological exam and thorough imaging review define which levels need decompression and fixation. Goals, approach, alternatives and risks are explained, addressing questions. Fasting instructions and medication adjustments (especially anticoagulants and antiplatelets) are given, and comorbidities are assessed with anaesthesia before consent.

2.During the procedure

Under general anaesthesia, the patient is usually positioned prone with the head secured. A midline posterior incision exposes the bone. Screws are placed in the lateral masses or pedicles, guided by anatomical landmarks, intraoperative imaging and sometimes navigation. Laminectomy or foraminotomy may be performed to decompress the cord and roots. Rods are connected, bone graft is added to promote fusion and the wound is closed, with a drain if needed.

3.Immediate postoperative period

After surgery, vitals, neurological status and pain are monitored in recovery and then on the ward. Muscle pain in the back of the neck and shoulders is common and managed with analgesia. Mobilisation starts gradually (sitting, standing, walking), often within the first 24–48 hours. Hospital stay is typically 3–5 days depending on pain, strength, gait and wound progress.

Recovery and daily life

Recovery is progressive and can be slower than anterior approaches due to posterior muscle dissection. Early weeks often bring muscle pain, fatigue and neck stiffness. Basic activity starts early while avoiding effort, lifting and sudden movements. Return to office work is usually considered between 4 and 6 weeks; physical or high-risk jobs may need 3–4 months or more. Physiotherapy, strengthening and posture correction are key. If fever, marked swelling, worsening pain, new weakness or gait change appears, prompt review is required.

Risks and possible complications

General risks: complications of general anaesthesia, wound infection, bleeding, haematoma and venous thrombosis. Specific risks: spinal cord or nerve root injury with possible worsening strength or sensation; lack of bone fusion (pseudoarthrosis); screw malposition that may require revision; residual or chronic neck pain; progression of degeneration at adjacent segments and risk of deformity if alignment is not maintained. These risks are always weighed against leaving significant stenosis or instability untreated.

Frequently asked questions

It usually takes between 2 and 4 hours depending on how many levels are fused and the extent of decompression. Additional time is needed for operating room preparation and the recovery period. The team will provide an estimate for your case.
You will not feel pain during surgery because it is done under general anaesthesia. Afterward, pain in the back of the neck and shoulder/upper back muscles is common, managed with analgesia and improving over days. Severe nerve-related pain often lessens as the cord and roots gain space.
For office-based jobs, return is usually considered between 4 and 6 weeks depending on progress. Physical jobs involving lifting, repetitive neck movements or fall risk may need 3–4 months or more. These timings are tailored during follow-up.
Gentle walking starts early and increases gradually. Impact or contact sports and activities requiring wide neck motion are reintroduced slowly, usually from around 3–4 months, following surgeon and rehab advice.
The surgery aims to stabilise and decompress treated levels, so the same instability is unlikely to recur at fused segments. Other levels may degenerate over time, and if neurological damage was advanced, recovery may be partial.
Anterior fusion works from the front on discs and vertebral bodies. Posterior fusion allows wide decompression from behind and very strong multilevel fixation. In complex cases both approaches can be combined. Choice depends on compression location, deformity, levels involved and surgical goals.
Not always. Mild, stable cases may be observed. With neurological symptoms, significant stenosis, instability or progressive worsening, surgery is often the most reasonable option. The decision is individual, balancing risks and benefits.

Do these symptoms sound familiar?

If you recognise yourself in some of these symptoms and your pain is starting to limit your daily life, we can review your case in a personalised consultation. Dr. Ben Ghezala will assess your clinical history and imaging studies to help you decide the best treatment option for you.

Request a consultation with Dr. Ben Ghezala
Posterior cervical fusion in Alicante