The goal of surgical management of multilevel cervical spondylotic myelopathy (CSM) is to decompress the spinal cord and restore a more physiologic sagittal alignment. Several surgical options for CSM exist, consisting of posterior and anterior procedures. Posterior decompression and stabilization in lordosis allow the spinal cord “back shift,” resulting in indirect decompression of the anterior neural elements. This video shows posterior decompression and instrumented fusion in a 59-year-old man affected by CSM at C5-C7, who had numbness and weakness in the upper extremities. The surgical steps shown include lateral mass identification by anatomic landmarks and lateral mass screw fixation technique according to Roy-Camille, cervical decompression by C5-C7 laminectomy, and attempted fusion via bone graft positioning. A total of 40 patients affected by multilevel CSM underwent this technique and were followed both clinically and electrophysiologically. Thirty-six patients were clinically assessed at a mean follow-up of 5.7 years. European myelopathy scale (EMS) scores, modified Japanese Orthopaedic Association (mJOA) scores, and Neck Disability Index scores improved significantly (P < 0.001). Ninety percent of patients would undergo the same surgery again. There was no deterioration of the cervical alignment, posterior grafted bones had completely fused, and there were no instrumentation failures. The mean spinal cord back shift was 3.9 mm (range, 2.5 to 4.5 mm). EMS and mJOA recovery rates were significantly correlated with the postoperative posterior cord migration (P < 0.05). Posterior decompression and stabilization in lordosis is a valuable procedure for patients affected by multilevel CSM, leading to marked clinical improvement resulting from the spinal cord back shift. Postoperative lordotic alignment of the cervical spine is a key factor for successful treatment.