Pterion Prep CraniPro VUMC Case Prep
2026-06-27

Case Prep: Posterior Cervical Laminectomy and Fusion

Case / Approach Snapshot

One-Liner

[Age]yo [M/F] with [multilevel cervical spondylotic myelopathy / OPLL] from [C_-C_] [with maintained lordosis] planned for posterior cervical laminectomy and instrumented fusion (lateral mass ± pedicle screws).

Figures, Imaging & Video

🎥 Operative video — search operative video on YouTube ▸ · The Neurosurgical Atlas ▸

🧭 Operative approach: Posterior cervical approach — detailed corridor setup, step-by-step technique & figures

Neurosurgical Atlas · AO Spine / Surgery Reference · Radiopaedia · PubMed Central — operative figures © linked; see media-sources.md

High-Yield Literature

Curated Image Set

Open-access figures are embedded from PubMed Central articles and kept unique to this guide.

Posterior Cervical Laminectomy Fusion — Figure 2. Figure 2.. Demonstration of US-guided ISP block. Source: Efficacy and Safety of Ultrasound Guided Inter-semispinal Plane Block for Postoperative Analgesia in Posterior Cervical Laminectomy - A Prospective Randomised Controlled Study — Global Spine Journal 2024; CC BY-NC-ND.

Posterior Cervical Laminectomy Fusion — Figure 3. Figure 3.. Mean heart rate distribution between two groups at various time intervals. Source: Efficacy and Safety of Ultrasound Guided Inter-semispinal Plane Block for Postoperative Analgesia in Posterior Cervical Laminectomy - A Prospective Randomised Controlled Study — Global Spine Journal 2024; CC BY-NC-ND.

Posterior Cervical Laminectomy Fusion — Figure 4. Figure 4.. Mean arterial pressure distribution between two groups at various time intervals. Source: Efficacy and Safety of Ultrasound Guided Inter-semispinal Plane Block for Postoperative Analgesia in Posterior Cervical Laminectomy - A Prospective Randomised Controlled Study — Global Spine Journal 2024; CC BY-NC-ND.

Posterior Cervical Laminectomy Fusion — Figure 5. Figure 5.. Average NRS between two groups at various time intervals. Source: Efficacy and Safety of Ultrasound Guided Inter-semispinal Plane Block for Postoperative Analgesia in Posterior Cervical Laminectomy - A Prospective Randomised Controlled Study — Global Spine Journal 2024; CC BY-NC-ND.

Posterior Cervical Laminectomy Fusion — Figure 6. Figure 6.. Average MOASS score between two groups at various time intervals. Source: Efficacy and Safety of Ultrasound Guided Inter-semispinal Plane Block for Postoperative Analgesia in Posterior Cervical Laminectomy - A Prospective Randomised Controlled Study — Global Spine Journal 2024; CC BY-NC-ND.

Posterior Cervical Laminectomy Fusion — Figure 7. Figure 7.. Average PONV score between two groups at various time intervals. Source: Efficacy and Safety of Ultrasound Guided Inter-semispinal Plane Block for Postoperative Analgesia in Posterior Cervical Laminectomy - A Prospective Randomised Controlled Study — Global Spine Journal 2024; CC BY-NC-ND.

Posterior Cervical Laminectomy Fusion — Fig. 1 Fig. 1. The evaluation of the C2–C7 Cobb angle and the SVA Source: Bridging the cervicothoracic junction during posterior cervical laminectomy and fusion for the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a retrospective case series — BMC Musculoskeletal Disorders 2022; CC BY.

Posterior Cervical Laminectomy Fusion — Fig. 2 Fig. 2. A 63-year-old male patient with multilevel, mixed-type ossification of the posterior longitudinal ligament. Preoperative computed tomography scan showed ossification of the posterior… Source: Bridging the cervicothoracic junction during posterior cervical laminectomy and fusion for the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a retrospective case series — BMC Musculoskeletal Disorders 2022; CC BY.

Posterior Cervical Laminectomy Fusion — Figure 1 Figure 1. Graphical diagram neurology (pre and postoperative) Source: The Efficacy of Posterior Cervical Laminectomy for Multilevel Degenerative Cervical Spondylotic Myelopathy in Long Term Period — Asian Journal of Neurosurgery 2019; CC BY-NC-SA.

History of Present Illness

Past Medical History

Imaging Review

X-ray (AP, lateral, flexion/extension)

Labs

Neurological Examination

Surgical Planning

Case Logistics, OR Needs & Orders

Position

Approach: Posterior Midline

Key Surgical Steps — Detailed

  1. Time-out and IONM baseline — confirm stable SSEP/MEP after pinning and prone positioning (myelopathic cord is vulnerable to positioning); document any signal change before incision
  2. Position confirmation — neck neutral-to-slightly-flexed to open the interlaminar spaces while preserving cervical lordosis for the fusion construct; ensure no chin-on-chest, eyes free, reverse Trendelenburg
  3. Midline incision and subperiosteal dissection — stay in the avascular midline raphe (ligamentum nuchae) to limit bleeding; expose laminae and lateral masses to their lateral edges bilaterally; preserve the C2-C3 and C7-T1 facet capsules at the construct ends if not fusing them
  4. Fluoroscopic level confirmation
  5. Lateral mass screws (Magerl or Anderson/An technique): entry ~1 mm medial to the center of the lateral mass; trajectory ~20-30° lateral and ~15-30° cephalad (parallel to the facet joint) to avoid the vertebral artery (too medial/ventral) and the exiting nerve root (too caudal); drill, probe all walls, tap, and place screws (typically 14 mm)
    • C7: lateral mass is thin → often a pedicle screw
    • C2: pars/pedicle screw (review VA anatomy on CT — high-riding VA contraindicates a C2 pedicle screw → use pars or translaminar)
    • Subaxial cervical pedicle screws give superior fixation but carry higher VA risk → navigation/robotics recommended
  6. Laminectomy: create bilateral troughs at the lamina–lateral mass junction with a high-speed drill (thin the inner cortex) then complete with fine Kerrisons; lift the lamina en bloc off the dura (free epidural adhesions first), decompressing the cord across all stenotic levels; meticulous epidural venous hemostasis (bipolar, hemostatic matrix)
  7. Foraminotomy — undercut the medial facet/foramen at symptomatic levels for radicular decompression; prophylactic C4-5 foraminotomy is sometimes done to reduce C5 palsy risk (surgeon preference)
  8. Rod placement — contour rods to maintain/restore lordosis, seat into the screw heads, and lock set screws; avoid distraction that flattens the cervical curve
  9. Arthrodesis — decorticate the lateral masses and facet joints (decorticate/curette the facet cartilage) and apply bone graft (local autograft from the laminectomy bone + allograft) for posterolateral fusion
  10. Hemostasis, subfascial drain, layered watertight closure (re-approximate the deep extensor musculature and fascia carefully — posterior cervical wounds are prone to dehiscence/infection)

Critical Anatomy & Structures at Risk

  1. Vertebral artery (lateral mass/pedicle screw trajectory) — catastrophic
  2. Spinal cord (decompression, screw breach) — myelopathic cord is vulnerable
  3. Nerve roots (foramina, screw trajectory), C5 root (C5 palsy — deltoid/biceps weakness after posterior decompression, often delayed)
  4. Facet joints (preserve unfused adjacent levels)

Equipment

Monitoring

Anesthesia

Potential Complications

  1. C5 palsy (delayed deltoid weakness, often recovers)
  2. Vertebral artery injury, cord injury, CSF leak
  3. Wound infection (higher posterior cervical), instrumentation failure, pseudarthrosis
  4. Loss of lordosis/kyphotic deformity, adjacent segment disease, ischemic optic neuropathy (prone)

Operative Note Template

Preoperative Diagnosis: Cervical spondylotic myelopathy [/ OPLL] with multilevel stenosis [C_-C_]

Postoperative Diagnosis: Same

Procedure: Posterior cervical laminectomy [C_-C_] and posterior instrumented fusion [C_-C_] with lateral mass [and pedicle] screws and posterolateral arthrodesis

Surgeon / Assistant: Anesthesia: General endotracheal EBL / Fluids / Blood products: Specimens: None Drains: Subfascial drain Implants: Lateral mass / pedicle screws and rods [system/sizes], bone graft (local autograft + allograft) Monitoring: SSEP / MEP / EMG — stable throughout [or note changes] Complications: None

Indications: [Age]yo [M/F] with progressive cervical myelopathy (mJOA [_], [gait/hand dysfunction]) due to multilevel stenosis [/ OPLL] from [C-C_] with preserved lordosis. After discussion of risks/benefits/alternatives (including anterior approaches), the patient elected posterior decompression and fusion.

Description of Procedure: Following consent and a time-out, general anesthesia was induced and neuromonitoring established with stable baselines. The head was secured in [Mayfield 3-pin] fixation and the patient carefully positioned prone with the neck neutral-to-slightly-flexed preserving lordosis, eyes free, in reverse Trendelenburg; signals were re-confirmed stable. The posterior neck was prepped and draped and antibiotics given.

A midline incision was made and subperiosteal dissection carried out through the midline raphe, exposing the laminae and lateral masses from [level] to [level]; levels were confirmed fluoroscopically. Lateral mass screws were placed at [levels] (Magerl technique, directed laterally and cephalad to protect the vertebral artery and nerve root) and [pedicle screws at C7/C2 as noted]; all walls were probed intact. Bilateral troughs were drilled at the laminolateral mass junctions and the laminae of [C_-C_] were removed en bloc, widely decompressing the thecal sac; [foraminotomies were performed at ___]. Hemostasis of the epidural venous plexus was obtained.

Contoured rods were placed to maintain cervical lordosis and the set screws were locked. The lateral masses and facet joints were decorticated and bone graft applied for posterolateral arthrodesis. Final fluoroscopy confirmed satisfactory hardware position and alignment. Neuromonitoring remained stable. The wound was irrigated, a subfascial drain placed, and closure performed in anatomic layers. The patient was awakened, moving all extremities [at baseline], and transferred to the [ICU/step-down] in stable condition.

Postoperative Plan

Chief-Level Case Review

Use these as the senior-level mental model for Posterior Cervical Laminectomy and Fusion:

Common Pimp Questions

Use these to pressure-test preparation for Posterior Cervical Laminectomy and Fusion:

  1. What neurologic level and root are responsible for the presenting deficit?
  2. What is the decompression target and how will you know it is adequately decompressed?
  3. What instability, deformity, bone-quality, or fusion variable changes the construct?
  4. What vascular, visceral, dural, or neural structure is the main structure at risk?
  5. What postop brace, drain, mobilization, MAP, antibiotic, and DVT plan should be ordered?

Attending Preference Variables

Items that commonly vary by surgeon or institution: