Minimally Invasive Posterior Cervical Fusion (DTRAX®) | Jonathan G. Hobbs, M.D.

The procedure

What Is Minimally Invasive Posterior Cervical Fusion?

Each level of the neck is joined by three joints: the disc in front and a pair of small facet joints at the back. When a facet joint wears out, or when the opening beside it narrows and pinches the nerve root to the arm (cervical foraminal stenosis), one option is to stop that joint from moving and let it heal into solid bone — a fusion.

Traditionally that meant either a fusion from the front of the neck (ACDF) or a long incision down the back with the neck muscles stripped off the bone. Minimally invasive posterior cervical fusion reaches the same facet joints from the back through two openings about a centimeter wide. Dr. Hobbs uses the Providence Medical Technology DTRAX® Spinal System: a set of narrow instruments that work between muscle fibers to open the joint, prepare its surfaces, and place a small cage packed with bone graft. The cage props the joint open, which also widens the exit tunnel for the nerve, and over the following months the joint fuses.

The approach does not go near the throat, esophagus, or voice box, and it leaves the front of the spine untouched — which is why it is also used to rescue an anterior fusion that never fully healed and to reinforce high-risk multilevel anterior fusions.

See the technique

Watch How the Procedure Works

This animation walks through the tissue-sparing posterior approach: reaching the facet joints through narrow instruments, preparing the joint, and placing the cage that props it open while it fuses.

Animation: “Posterior Cervical Fusion Technique.” Educational illustration of the technique — not footage of an actual patient.

Interactive — step by step

How the Fusion Is Built, One Joint at a Time

Tap each step to see what happens at a single facet joint. The same sequence is repeated on the other side.

Access the facet joint01 / 04

A narrow guide tube reaches the joint from behind.

Simplified illustration for education — not an exact anatomical depiction. Fixation screws may be added when extra stability is needed.

Who it is for

Who Is a Candidate?

This is a targeted tool, not an all-purpose neck operation. Dr. Hobbs considers it for skeletally mature adults with degenerative disease between C3 and C7 who have:

At least six weeks of conservative care first

Physical therapy, medication, and often an injection have been tried without lasting relief. Surgery is not the first step.

Arm pain, numbness, or burning from foraminal stenosis

A nerve root pinched in its exit tunnel at the back of the neck. Propping the facet joint open widens that tunnel. See radiculopathy.

Neck pain from a worn-out facet joint

Facet arthritis that has been confirmed as the pain source, where fusing the joint stops the painful motion.

An anterior fusion that did not heal

A pseudarthrosis after ACDF can be stabilized from behind without reopening the front of the neck. Also used to reinforce high-risk multilevel anterior fusions.

When Dr. Hobbs recommends something else

Spinal cord compression (myelopathy). The cord needs direct decompression, usually from the front or with a laminectomy or laminoplasty. See cervical myelopathy.
A large herniated disc pressing from the front. That fragment is removed through an anterior approach; a posterior fusion does not reach it.
Instability or deformity that needs realignment. Those call for conventional fixation and correction planned to your alignment.

Compare

Three Ways to Fuse a Level in the Neck

Each approach has a job it does best. The right one depends on what is being compressed and from where.

	Tissue-sparing posterior fusion (DTRAX)	ACDF (from the front)	Traditional open posterior fusion
Where the incision is	Back of the neck: two openings about 1 cm wide	Front of the neck, in a skin crease	Midline of the back of the neck, several inches
Muscle	Spread apart between fibers, not cut	Little muscle, but works past the esophagus and voice-box nerves	Neck muscles stripped from the bone and retracted
What it is best at	Foraminal stenosis and facet pain; rescuing a non-healing ACDF	Removing a disc or bone spur pressing the cord or nerve from the front	Instability, multilevel cord compression, deformity
Typical stay	Same day or one night in published series	Usually one night	Usually several nights
Trade-offs	Cannot remove a disc from the front; not for cord compression	Temporary swallowing trouble or hoarseness is common early on	More postoperative pain and a longer recovery

Sometimes approaches are combined — for example, a posterior tissue-sparing fusion added behind a multilevel ACDF. Dr. Hobbs matches the approach to your imaging and symptoms.

Evidence

What the Published Studies Show

The DTRAX system received FDA 510(k) clearance in 2018 for posterior cervical fusion in patients with cervical degenerative disc disease, and the tissue-sparing technique has been studied in peer-reviewed series for more than a decade.

93%Bridging bone across the facet joints at one year

In 60 patients treated for single-level cervical radiculopathy, with no reoperations and no device-related complications reported.

McCormack et al., J Neurosurg Spine, 2013

52minMean operating time, with about 14 mL of blood loss

Across 150 cases in which the technique was used to revise an anterior fusion that had not healed; no wound infections were reported.

Lemons et al., J Craniovertebr Junction Spine, 2024

~1dayMedian hospital stay

In a 271-patient device registry, with procedure times of roughly 51 to 88 minutes and blood loss of 32 to 75 mL depending on the number of levels.

Siemionow et al., J Spine Surg, 2018

12moNerve exit tunnel measurably larger at 6 and 12 months

Cages placed in both facet joints from behind increased foraminal area and height in 43 patients, the mechanism behind arm-pain relief.

Siemionow et al., Eur Spine J, 2016

About these numbers. They come from published studies of the technique and device, not from Dr. Hobbs’s own patients, and study populations differ from any one person. A 2020 systematic review (Laratta et al., Global Spine Journal) found the evidence encouraging but still limited to smaller series. Dr. Hobbs will explain how they apply to your situation.

Recovery

Recovery & Healing

The cage does its job immediately. The bone takes longer. Here is how the two timelines fit together.

Surgery Day
General anesthesia; the procedure itself typically takes about an hour for one level. Most patients are walking within hours and go home the same day or after one night, with two small dressings at the back of the neck.
The First Weeks
Walking and light daily activity resume quickly. Heavy lifting and forceful neck motion are limited while the joint begins to heal. Arm pain from a pinched root often eases early; soreness at the openings fades over a couple of weeks.
3 to 6 Months
This is when bone actually bridges the facet joint. Activity is increased step by step, therapy rebuilds neck strength, and Dr. Hobbs confirms healing on follow-up imaging. Your plan is tailored to the number of levels treated and your health.

Technology

Part of a Minimally Invasive Practice

Posterior cervical fusion with DTRAX sits alongside the other tissue-sparing tools Dr. Hobbs uses to treat the spine with the smallest footprint that solves the problem.

Minimally Invasive Technique
Muscle-sparing approaches across the spine

Image-Guided Navigation
Real-time guidance confirms the level and the path

Outpatient Spine Surgery
Same-day procedures at an ambulatory surgery center

Spinal Fusion & Stabilization
How fusion works, and when motion-preserving options fit

Jonathan G. Hobbs, M.D.

Board-Certified Neurosurgeon · Spine Surgery

ABNS
Certified

Residency
Chicago

M.D.
Kentucky

Why Dr. Hobbs

Why Choose Dr. Hobbs for Posterior Cervical Fusion

Neurosurgeon — Cord & Nerve Expertise
Trained specifically in surgery of the spinal cord and nerves, so the choice between decompression and fusion is made by a specialist in both.
Minimally Invasive Focus
Specialty-trained in tissue-sparing techniques; most of his procedures are outpatient.
Conservative-First
At least six weeks of nonsurgical care comes before this operation is considered.
Revision Experience
Rescuing anterior fusions that did not heal is part of his revision spine practice.
Elite Training
University of Kentucky medical degree; neurosurgery residency at the University of Chicago, serving as chief resident.
Lakeshore Bone & Joint Institute
Practicing at Northwest Indiana's most preferred orthopedic and spine practice, with offices in Crown Point & Chesterton.

Call (219) 250-5010 The full surgical process

Related: Cervical stenosis· Cervical herniated disc· Radiculopathy· Cervical MRI guide

Frequently Asked Questions About Posterior Cervical Fusion

It is a fusion of one or more levels of the neck performed from the back through two openings about a centimeter wide. Narrow instruments work between the muscle fibers to reach the facet joints, prepare the joint surfaces, and place a small cage packed with bone graft in each joint. The cage props the joint open, which widens the nerve’s exit tunnel, and the joint fuses over the following months. Dr. Hobbs performs it with the Providence Medical Technology DTRAX® system.

DTRAX® is a set of single-use instruments made by Providence Medical Technology for access, bone preparation, bone graft delivery, and implant placement in posterior cervical fusion. Every instrument is narrower than one centimeter. It received FDA 510(k) clearance in 2018 for posterior cervical fusion in patients with cervical degenerative disc disease. The small interfacet cages placed with it are part of the same tissue-sparing system.

Adults with degenerative disease between C3 and C7 who have completed at least six weeks of conservative care and still have arm pain, numbness, or burning from cervical foraminal stenosis, neck pain from a worn facet joint, or an anterior fusion that did not heal. It is not the right operation when the spinal cord itself is compressed, when a large disc fragment must be removed from the front, or when alignment needs to be corrected. Dr. Hobbs confirms candidacy with an examination and imaging.

ACDF (anterior cervical discectomy and fusion) works from the front of the neck, removes the disc, and fuses the level with a spacer and plate. It is the right choice when a disc or bone spur is pressing the cord or nerve from the front. Posterior tissue-sparing fusion works from the back, leaves the disc and the front of the neck alone, and fuses the facet joints instead. It avoids the temporary swallowing and voice problems that can follow an anterior approach, and it can be added behind an ACDF that has not healed.

Yes, this is one of its most common uses. A pseudarthrosis after ACDF can be stabilized from behind by fusing the facet joints at the same level, without reopening the scar at the front of the neck. In a published series of 150 such cases, the mean operating time was about 52 minutes with roughly 14 mL of blood loss and no wound infections. Dr. Hobbs evaluates every non-healing fusion individually as part of his revision practice.

The procedure typically takes about an hour for one level. Most patients walk within hours and go home the same day or after one night; published registries report median stays of about one day. Light activity resumes quickly, heavy lifting and forceful neck motion are limited while the joint heals, and the bone bridges the facet joint over roughly three to six months, which Dr. Hobbs confirms on follow-up imaging. He gives every patient an individualized recovery plan.

Yes. Jonathan G. Hobbs, M.D. is a board-certified neurosurgeon who performs tissue-sparing posterior cervical fusion with the Providence Medical DTRAX® system for appropriate patients. He practices at Lakeshore Bone & Joint Institute, with offices in Crown Point & Chesterton, Indiana. Call (219) 250-5010 to schedule a consultation.

Find Out If a Smaller Neck Operation Fits Your Problem.

If arm pain, a worn facet joint, or a fusion that never healed has you weighing surgery, Dr. Hobbs will review your imaging and explain whether tissue-sparing posterior fusion, an anterior approach, or continued conservative care is the right next step.

(219) 250-5010

Monday – Friday · 8:00 AM – 5:00 PM

Crown Point Office

500 E. 109th Avenue
Crown Point, IN 46307

Chesterton Office

601 Gateway Boulevard
Chesterton, IN 46304

Minimally Invasive Posterior Cervical Fusion