By Mr Ahmed-Ramadan Sadek, Neurosurgeon · Last reviewed October 2026 · 7 min read

Why operate from the back?

The back wall of the spinal canal is formed by thin plates of bone called laminae. Worn discs, bony spurs and thickened ligaments can narrow the canal (cervical stenosis) and squeeze the cord, a condition known as cervical myelopathy. Narrowing at the side can pinch a single nerve root and cause cervical radiculopathy.^[1]

Your surgeon chooses between the front and the back depending on where most of the pressure comes from, and occasionally does both, usually at separate operations.^[1] The back is often favoured when narrowing spans several levels or comes from thickened ligaments and spurs behind the cord. When spurs on the vertebral bodies are the main problem, a front operation such as ACDF or corpectomy (removing a vertebral body and replacing it with a cage or bone strut) may suit better.^[1] For a trapped nerve, foraminotomy is often chosen for people who have already had front-of-neck surgery, because operating again through scar tissue carries more risk.^[2]

Who is it for?

An international AO Spine guideline recommends surgery for moderate and severe degenerative cervical myelopathy. For mild disease it suggests surgery or a supervised trial of structured rehabilitation, with surgery if things worsen. It advises against operating on people whose scans show cord compression without symptoms; they should instead learn the warning signs and be followed up.^[3]

BASS explains that pressure on the cord will not ease by itself and that results are best before severe damage sets in. Halting the decline without any loss of function counts as a success.^[1]

For arm pain from a trapped nerve, most people improve without surgery, helped by painkillers, physiotherapy or nerve root injections. Foraminotomy is considered when pain persists or the nerve is weakening.^[2]

The operations

You lie face down under general anaesthetic, with your head held still in a frame (a Mayfield clamp) fixed by three pins that are placed and removed while you are asleep. The surgeon works through a midline cut, moving the muscles aside to reach the laminae.^[1]

Laminectomy, with or without fusion

A high-speed drill cuts a groove each side and the laminae and spurs are lifted away, letting the cord drift back from the pressure. Removing the roof over several levels can let the neck tip forwards in time, so surgeons often add screws at the side of each vertebra (lateral mass screws) joined by rods, with bone graft to fuse the levels. The metalwork is rarely removed.^[1] Skip laminectomy, a variation, treats alternate levels and leaves muscle attachments alone, so no fixation is needed.

Laminoplasty

The laminae are cut fully through on one side and partly on the other, forming a hinge. The bone swings open like a door and is held by a small spacer of bone, metal or plastic. In the French door version both sides are hinged and the opening is in the middle. The canal widens without fusion, so the neck keeps more movement.^[1]

Laminotomy and foraminotomy

These smaller operations suit arm pain with little or no cord compression. A small window of bone, usually on one side, is removed to free the nerve root. As most of the lamina stays, no fixation is needed, and some surgeons work through a narrow tube to spare muscle.^[1][2]

Before the operation

• Let the team know about blood thinners (such as warfarin, aspirin, clopidogrel or rivaroxaban) and anti-inflammatory painkillers, as some may need stopping.^[1]
• If fusion is planned, stop smoking and all nicotine, ideally 2 to 3 months beforehand. BASS names smoking as the factor most likely to stop bones fusing.^[1]
• BASS advises stopping the combined pill or oestrogen-containing HRT four weeks before surgery.
• Arrange a lift home, as driving or public transport is not advised at first.

After the operation and recovery

You will usually wake sitting up. A drain is normally removed the following day, a physiotherapist helps you get moving, and most people go home 1 to 2 days after surgery.^[1] Any recovery in hand function or walking may be slight and can take a year or so. A small number of people need a spell of specialist rehabilitation in a spinal injuries unit.^[1]

• Driving: usually after 2 to 4 weeks, when you can turn your head freely and could make an emergency stop. Build up sitting time over 4 to 8 weeks.
• Work: around four weeks off for many people, up to eight weeks for heavy jobs. If you had more severe damage beforehand, check with your consultant.
• Activity: walk often, avoid heavy lifting for the first few weeks and possibly up to three months, and check before returning to sport.
• Flying: your surgeon may advise not flying for six weeks, with long-haul travel delayed for up to three months.
• Follow-up: X-rays are commonly taken at clinic to check bone healing and implant position.^[1]

Risks and complications

These figures are from the BASS myelopathy booklet.^[1] Fusion problems only apply when a fusion is done.

Risk	Approximate frequency (BASS)
Superficial wound infection	Up to 4 in 100
Deep wound infection	Fewer than 1 in 100
Damage to a nerve root	Fewer than 1 in 100 at a first operation; up to 10 in 100 in repeat surgery
Tear in the lining around the nerves (dura)	Fewer than 5 in 100
Further operation for a persistent fluid leak	Less than 0.05% (under 5 in 10,000)
Blood clot in the leg or lung	Fewer than 1 in 100
Bones failing to fuse (when fusion is done)	Up to 5 in 100
Death from injury to a major blood vessel	About 1 in 10,000
Fatal complication of general anaesthetic	About 1 in 250,000

BASS also lists pressure and eye injuries from lying face down (very rarely loss of sight), a slight risk that neck screws injure the vertebral artery and cause a stroke or serious bleeding, and, very rarely, spinal cord damage. Symptoms can return, and other levels may cause trouble later.^[1]

C5 palsy, new weakness in the muscles that lift the arm at the shoulder, deserves a mention. A meta-analysis of over 21,000 patients found it in about 6% after laminoplasty, 10% after laminectomy and fusion and 4% after front-of-neck fusion. Recovery typically took five to eight months, and a fifth to a third of those affected kept some weakness.^[4]

In a randomised trial for multilevel myelopathy, overall complications were less frequent after back surgery than front surgery (24% against 48%), mainly because swallowing problems were avoided. New nerve problems (9% against 2%) and 30-day readmissions (7% against 0%) were more common after back surgery.^[5]

What does the evidence show?

That trial, involving 163 people, found no meaningful difference in physical function one year after surgery from the front or from the back.^[5] The choice therefore rests on the pattern of compression rather than one approach being better overall.

Laminoplasty and laminectomy with fusion have mostly been compared in observational studies. A review of 12 retrospective studies (7,581 patients) found that laminectomy with fusion cost more in US hospitals but gave somewhat better pain relief. In the one study that measured it, more people were back at work at 12 months after laminoplasty (89% against 64%). The authors called the evidence limited.^[6]

For a trapped nerve, a review found that minimally invasive foraminotomy and ACDF had similar hospital stays, complication rates and reoperation rates. Compared with disc replacement, foraminotomy had fewer complications but more reoperations.^[7] BASS reports good relief of arm pain in about 85 to 90% of people after surgery for a trapped nerve in the neck, while relief of neck pain is less predictable.^[2]

Contact your hospital team or GP if the wound becomes red, leaks or you develop a high temperature.

References

1. British Association of Spine Surgeons. Cervical Stenosis and Myelopathy: Surgical Options (patient booklet, issue 3). BASS; 2021. Link
2. British Association of Spine Surgeons. Cervical Disc Protrusion and Radiculopathy: Surgical Options (patient booklet, issue 3). BASS; 2021. Link
3. Fehlings MG, Tetreault LA, Riew KD, et al. A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression. Global Spine J. 2017;7(3 Suppl):70S-83S. Link
4. Muthu S, Kalanchiam GP, Munisamy S, Viswanathan VK. Incidence of C5 palsy in anterior cervical decompression and fusion, posterior cervical decompression and fusion and laminoplasty for degenerative cervical myelopathy: systematic review and meta-analysis of 21,231 cases. Asian Spine J. 2026;20(1):158-175. Link
5. Ghogawala Z, Terrin N, Dunbar MR, et al. Effect of ventral vs dorsal spinal surgery on patient-reported physical functioning in patients with cervical spondylotic myelopathy: a randomized clinical trial. JAMA. 2021;325(10):942-951. Link
6. Karthikeyan V, Shakil H, Lozano CS, et al. Laminoplasty versus laminectomy and fusion in the treatment of degenerative cervical myelopathy: a systematic review and meta-analysis of cost and patient-centered outcomes in the United States. Global Spine J. 2026;16(1 Suppl):43S-52S. Link
7. Fang H, Cui M, Zhao K, et al. Minimally invasive posterior cervical foraminotomy versus anterior cervical fusion and arthroplasty: systematic review and updated meta-analysis. Brain Spine. 2024;4:102852. Link

This guide is general information and is not a substitute for advice about your own situation. Please discuss the benefits and risks of any procedure with your surgeon.