Posterior Cervical Fusion

Posterior cervical fusion means operating the neck from the back and doing a fusion surgery so as to stabilize the neck. This surgery is usually performed in conjunction with laminectomy. Laminectomy means removing the bone and the tissue from the back of the spinal cord in the neck. Laminectomy is performed to remove the pressure from the spinal cord and possibly nerve roots if needed.

Laminectomy in itself is bound to fail by causing instability of the neck. Posterior cervical fusion provides stability to the neck after laminectomy, to avoid late failures, which can be disastrous.

The surgery of posterior cervical fusion and laminectomy is usually performed on a long segment covering almost 50-70% of the neck as compared to the surgery from the front, which includes anterior cervical discectomy and fusion (ACDF) and Total disc replacement (TDR) and is done at shorter levels of 1 to 3 levels only.

Posterior cervical fusion and laminectomy is usually performed over 4 to 6 segments depending on the need. As it is a fusion surgery, it also leads to more stiffness, but the patients who usually need this surgery are already stiff and have pathology or disease, which can be properly taken care of from the surgery from the back of the neck only. If the disease is localized and can be taken care of from the front, then surgery from the front is preferred.

Cervical Spine X-ray in Lateral view.

Cervical Spine X-ray in Lateral view.

Posterior Cervical Fusion Indications

The most common and widely used indication for laminectomy and posterior cervical fusion is cervical spondylotic myelopathy (CSM). CSM is defined as arthritic changes on the neck due to the ossification of the ligaments or disc disease, which causes compression of the spinal cord leading to changes in the neurological status of a patient.

CSM usually presents with weakness in the upper extremity only or in all four extremities. It may be associated with tingling and numbness. It may also be associated with gait problems due to imbalance and bowel and bladder issues. Patients with such a presentation may either stay stable or deteriorate.

Patients who deteriorate over time can only be treated by surgical options in an attempt to stop the progression and allow recovery. If the surgery involves multiple levels then surgery from the back is a good option to take care of the disease.

Multilevel compression of the spinal cord due to arthritic changes is the most common indication for this surgery. Patients with a small canal, which can be there since birth is at a higher risk of this disease process. For patients who are deteriorating neurological status, surgery is the only good option to halt the progression and possibly allow recovery of the neurological status.

Posterior Cervical Fusion Procedure 

Posterior laminectomy and posterior cervical fusion are done from the back of the neck. It is a major spine surgery, which requires meticulous preparation and skills and instrumentation of the highest quality to carry it out. A thorough discussion with the patient is done before the surgery with regards to expectations and results. All relevant clearances from all the needed specialties as well as the anesthesia team are taken.

The patient is taken to the operating room where general anesthesia is used. A tube is passed into the windpipe to control respiration and breathing. The anesthesia team puts the patient onto multiple monitoring systems. Neurologic monitoring is also used to check the patient’s neurological status during the surgery. The neurological monitoring checks sensory as well as motor functions.

Once everything is in place, the patient is turned onto his belly on the operating table. The head of the patient is usually fixed to the table by the use of tongs (pins). Once a good position is managed, the shoulders are strapped. X-ray in the operating room is used to check the position of the neck as well as the levels.

A straight midline incision is used from the base of the head along the back of the neck. By meticulous dissection and control of bleeding, the bone on the back of the spine is reached and the muscles are separated from the bone. The back part of the vertebrae of the neck is removed meticulously with the use of bur at all the levels required.

Once the bone is removed, the spinal cord is exposed. Further, necessary cleaning up or decompression of the spinal cord is done with the use of precision instruments, this procedure is done at multiple levels as needed.

Now, the screws are planned into the outer part of the vertebral body (lateral mass). The screws are planned at each level, which needs to be fixed so as to prevent the instability from laminectomy and allow fusion. Once the screws are put in place, rods are put to fix the screws on either side to each other.

If the patient has radicular symptoms then a foraminotomy can also be performed at the same time. If there is a deformity then further excision of the facet joints allows the correction of the deformity before the rod fixation. Once the implants are in place and tightened, final pictures are checked with the x-ray.

The facet joints which are of the vertebrae, which are to be fused are decorticated with the use of a bur and bone graft is put over the area of the facets to allow fusion. The central part of the spine and the spinal cord are checked to be thoroughly decompressed. The wound is thoroughly washed and drained. Blood oozings are controlled.

Closure of the wound is done in layers. Vancomycin antibiotic powder is used, which allows the prevention of infection. The skin is closed and the patient is turned onto the back. A collar may be put after the surgery over the dressing. The tube is usually removed by the anesthesia after the surgery. Occasionally, the patient may need to go to ICU with or without the tube for a day for critical monitoring.

Posterior Cervical Fusion Recovery

Patients after laminectomy and posterior cervical fusion heal gradually over time. These patients may need to go to the rehab depending on their neurological status before and after the surgery. The recovery in the neurological status can take some time. The recovery may not be complete as the recovery of the spinal cord and nerves is unpredictable. The surgery helps in stopping further deterioration of the neurological status, and at the same time optimizing the conditions for the spinal cord to recover as much as it can.

Posterior Cervical Fusion Complications

Laminectomy and posterior cervical surgery is major surgery and has risks and complications. A surgery can lead to further deterioration of neurological status due to injury to the spinal cord and nerve roots. Weakness of muscles of one or both shoulders can happen after surgery. There is a risk of bleeding and need for blood transfusion. There is rare risk of injury to the vertebral artery.

Other risks include dural tear, implant failure, failure of fusion, incomplete recovery, failure of the adjacent segment. Other risks include infection and wound dehiscence, which is more common in surgeries from the back of the neck than the front.

Posterior Cervical Fusion Conclusion

Laminectomy and posterior cervical fusion surgery is done in carefully selected patients can help prevent further deterioration of neurological symptoms as well as help in the recovery of the neurological deficits that have already happened. This surgery has higher risks and complications than the surgery from the front, but in carefully selected patients can be helpful and critical.

Overall, the risks and complications are more from surgery from the back than the front of the neck. For the same reason, surgeries on the front of the neck are preferred, but in patients who have multilevel involvement and compression involved from the back are not good candidates for surgery from the front and need to be treated from the back.

Call Us Now!

Based on 115 reviews
Dr. Karlkare and his staff were excellent. Dr. Karkare explained everything clearly and took his time getting to know my Dad.
Anna Acker
22:46 07 Sep 23
Dr Vedant Vaksha had done emergency surgery in 2020 after a traumatic injury.His office at Complete Orthopedics handled the continued care thereafter.Dr V and his staff had been Professional and friendly throughout the process, taking the time to explain all the questions on how to proceed and what to expect.Whenever I needed to speak with Dr V or the office they were a phone call away, without waiting or calling several numbers like in so many other medical offices.The office was accommodating to scheduling to my needs at all times. Dr Vedant Vaksha earned the following5 out of 5 stars, highly recommended.
John Kuey
20:58 05 Sep 23
Dr. Vaksha helped me recover from an injury. I am very thankful that he took the time to explain the best treatment for my injury. Also thankful for the wonderful office staff!
Joseph Castelli
22:30 02 Aug 23
The office is wonderful!… Dr Paresh was very helpful and attentive and made my sister in laws recovery so much better.. Thank you for everything
Jazz Lorenzo
17:48 14 Jul 23
The ladies are very welcoming, the service is great, the doctor is very professional and caring and the building is super clean. I really like to come here, the atmosphere is very friendly... Come and you will love it too.
Joan Carasco
14:41 30 Jun 23
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.