Posterior Approach to the Cervical Spine

Posterior approach to the cervical spine from C3 to C6 after bilateral subperiosteal dissection, exposing the spinous processes (SP) and lam
Posterior approach to the cervical spine from C3 to C6 after bilateral subperiosteal dissection, exposing the spinous processes (SP) and laminae (L) on both sides (B). Panel A shows the unilateral exposure used for a hemilaminectomy. Image from Kim JM, Cho YE, Kim KS, Jang HJ, Moon BJ, Shin JJ. Sagittal Alignment and Segmental Mobility After Cervical Intradural Extramedullary Tumor Surgery, A Comparative Analysis of Unilateral Hemilaminectomy and Laminotomy with Laminoplasty. J Clin Med. 2026, 15(7), 2672. CC BY 4.0.
Posterior Approach to the Cervical Spine, lateral radiograph of the cervical spine
Lateral radiograph of the cervical spine. Image by Staff at the Department of Radiology, UC San Diego Health., Wikimedia Commons, Public domain.

Indications

  • Entire cervical spine
    • Posterior spinal fusion
    • Herniated discs
    • Tumours
    • Facet joint dislocations
    • Nerve root exploration

Position

  • prone
  • mayfield head rest
    • flex head a few°
  • Prep & Drape

Landmarks

  • Spinous processes
    • C2
    • C7
    • T1
  • Identify level with Spinal needle & II

Incision

  • Straight longitudinal midline incision

Internervous Plane

  • Left & right paracervical muscles
    • Supplied segmentally by posterior rami

Superficial Dissection

  • Continue incision down to spinous processes
  • Reflect paraspinal muscles subperiosteally using a Cobb Elevator
  • Carry the dissection laterally to reveal the Lamina, Facet Joints, & Transverse Processes

Deep Dissection

  • Identify Ligamentum Flavum & remove it from the Superior edge of the Inferior Lamina
  • Perform a laminotomy / laminectomy
  • Expose blue white dura & epidural fat
  • Gently retract the spinal cord medially to expose the vertebral body, disc space
  • Watching for the thin epidural veins

Dangers

  • Nerves
    • Spinal cord
    • Nerve roots
  • Vessels
    • Venous plexus in the cervical canal

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.