Posterior Surgery for Cervical Myelopathy: Laminectomy, Laminectomy with Fusion, and Laminoplasty

Posterior decompression of the spinal cord is often used in patients with multilevel cervical myelopathy. In particular, those with appropriate sagittal alignment to allow cord drift-back away from anterior causes of cord compression (osteophytes, bulging discs, herniated discs, ossification of the posterior longitudinal ligament) after release of the posterior structures (lamina, ligamentum flavum) are the best candidates for a posterior procedure. Neurologic outcomes are similar with anterior or posterior approaches in the properly chosen patient. Laminectomy, laminectomy and fusion, and laminoplasty are potential posterior approaches. Laminoplasty has the advantages of better preserving alignment than laminectomy while maintaining motion and avoiding fusion related complications. Patients with painless myelopathy and neutral to lordotic alignment are the best candidates for laminoplasty.