Posterior neck deformity with an unsightly crater-like defect may result after cervicothoracic laminectomies. The authors present a new technique, spinous process reconstruction, to address this problem. A 64-year-old man presented with progressive quadriparesis secondary to cervical spondylotic myelopathy. Previously he had undergone multiple neck surgeries including cervicothoracic decompressive laminectomy. Postoperatively, he developed severe craniocervical spinal deformity and a large painful concave surgical defect in the neck. The authors performed craniocervical decompression and craniocervicothoracic instrumented stabilization. At the same time, cervicothoracic spinous process reconstruction was performed using titanium mesh to address the defect. Cervicothoracic decompressive laminectomy results in varying degrees of neck defect with resulting unsightly and an often painful surgical wound defect despite an appropriate multilayer closure. The presented spinous process reconstruction is a simple technique to address this problem with good clinical outcome.