PCDF (Posterior Cervical Decompression and Fusion)

Overview

PCDF — Posterior Cervical Decompression and Fusion — is a powerful procedure that addresses both spinal cord compression and cervical instability through a single posterior approach. It is indicated for patients with multi-level cervical stenosis causing myelopathy, particularly when there is associated kyphosis, instability, or when the compression extends behind the vertebral bodies. Dr. Basques performs a laminectomy (removing the bony roof of the spinal canal) at the compressed levels to give the spinal cord room, then stabilizes the spine with lateral mass screws connected by titanium rods. Bone graft is placed along the decorticated facet joints and lamina edges to promote fusion over time. The decompression stops the progression of myelopathy, while the fusion prevents late instability or kyphotic deformity that can occur when laminectomy is performed alone.

How It Works

Under general anesthesia, the patient is positioned face-down on a special frame that keeps the neck in optimal alignment. A midline incision is made in the back of the neck. The paraspinal muscles are elevated to expose the laminae, facet joints, and lateral masses at the affected levels. Using a high-speed burr and fine instruments, Dr. Basques performs a complete laminectomy — removing the laminae and ligamentum flavum — to decompress the spinal cord. Foraminotomies are performed as needed to free compressed nerve roots. Lateral mass screws are then placed at each level using anatomical landmarks and intraoperative imaging for precision. Titanium rods are contoured to restore or maintain cervical lordosis and locked to the screws. Bone graft is applied along the lateral masses and facet joints. The incision is closed in layers. The procedure typically takes 3–4 hours depending on the number of levels.

Benefits

Who Is a Candidate?

Ideal candidates have multi-level cervical stenosis with myelopathy plus either cervical kyphosis, instability, or compression predominantly posterior to the vertebral bodies. Patients who have failed or are not candidates for anterior approaches may also be candidates. Factors like age, bone quality, and medical comorbidities are considered. Dr. Basques performs a complete imaging workup (MRI, CT, X-rays with flexion/extension) before recommending PCDF.

Recovery & Aftercare

Hospital stay is typically 2–3 days. A hard or soft collar may be used for 4–6 weeks. Light activities resume after 2–3 weeks. Return to desk work is typically 6–8 weeks. Physical therapy begins at 6–8 weeks. Full recovery takes 6–12 months. The goal is to halt myelopathy progression and allow the spinal cord to recover. Dr. Basques provides detailed activity restrictions during the fusion healing period.

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