Cervical spinal fusion (arthrodesis) is a surgery that joins selected bones in the neck (cervical spine ). There are different methods of performing a cervical spinal fusion:

• Bone can be taken from elsewhere in your body or obtained from a bone bank (a bone graft). The bone is used to make a bridge between vertebrae that are next to each other (adjacent). This bone graft stimulates the growth of new bone. Man-made (artificial) fusion materials may also be used.
• Metal implants can be used to hold the vertebrae together until new bone grows between them.
• Metal plates can be screwed into the bone, joining adjacent vertebrae.
• An entire vertebra can be removed, and the spine then fused.
• A spinal disc can be removed and the adjacent vertebrae fused.

This procedure can be performed through an incision on the front (anterior) or back (posterior) of the neck.

Cervical Fusion Candidates

When surgery is the only option, persons with nerve root compression in their neck may undergo a cervical spine fusion.

Cervical spinal fusion is ideal for candidates for the following reasons:

• After an injury, to stabilize the neck and prevent a bone fracture from causing instability or damage to the spinal cord , which may result in paralysis.
• To treat conditions such as misalignment of the vertebrae.
• As a follow-up procedure to treat spinal stenosis, a herniated disc, the effects of rheumatoid arthritis, an infection, tumors, or spinal deformities.
  

Cervical Fusion Outcome & Benifits

Cervical spinal fusion is usually successful in relieving symptoms, but complications sometimes occur. Repeat surgery is sometimes needed to address complications or recurrence.

Cervical Fusion is Helpful in Treating:

• Bulging and herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation and swelling occurs when this material squeezes out and painfully presses on a nerve.
• Degenerative disc disease: As discs naturally wear out, bone spurs form and the facet joints inflame. The discs dry out and shrink, losing their flexibility and cushioning properties. The disc spaces get smaller. These changes lead to foraminal or central stenosis or disc herniation.
  

Prepare for Cervical Fusion

You may be scheduled for presurgical tests (e.g., blood test, electrocardiogram, chest X-ray) several days before surgery. In the doctor's office, you will sign consent and other forms so that the surgeon knows your medical history (allergies, medicines/vitamins, bleeding history, anesthesia reactions, previous surgeries). Discuss all medications (prescription, over-the-counter, and herbal supplements) you are taking with your health care provider. Some medications need to be continued or stopped the day of surgery.

Stop taking all non-steroidal anti-inflammatory medicines (Naprosyn, Advil, Motrin, Nuprin, Aleve, etc.) and blood thinners (Coumadin, Plavix, etc.) 1 to 2 weeks before surgery as directed by the doctor. Additionally, stop smoking, chewing tobacco, and drinking alcohol 1 week before and 2 weeks after surgery because these activities can cause bleeding problems. No food or drink is permitted past midnight the night before surgery.

The most important thing you can do to ensure the success of your spinal surgery is quit smoking. This includes cigarettes, cigars, pipes, chewing tobacco, and smokeless tobacco (snuff, dip). Nicotine prevents bone growth and puts you at higher risk for a failed fusion. Patients who smoked had failed fusions in up to 40% of cases, compared to only 8% among non-smokers. Smoking also decreases your blood circulation, resulting in slower wound healing and an increased risk of infection. Talk with your doctor about ways to help you quit smoking: nicotine replacements, pills without nicotine (Wellbutrin, Chantix), and tobacco counseling programs.

Cervical Fusion Surgery Overview

Most neck pain is due to degenerative changes that occur in the intervertebral discs of the cervical spine and the joints between each vertebra. The vast majority of patients who have neck pain will not require any type of operation. However, if the non-operative treatments fail to control your pain, your surgeon may suggest a cervical fusion to try to reduce your neck pain.

Surgical Steps

Anterior Interbody Fusion

This type of fusion is much more common in the neck. This type of fusion is described above. In the interbody fusion, a bone graft is placed between two vertebrae and replaces the removed disc. During the healing process, the vertebrae grow together, creating a solid piece of bone out of the two vertebrae.

Posterior Fusion

You may hear the term posterior fusion as well. In the posterior fusion, the bone graft is placed on the back side of the vertebrae. During the healing process, the vertebrae grow together, creating a solid piece of bone out of the two vertebrae. This type of fusion is only rarely used in the cervical spine, generally only for fractures of the spine. If surgery is necessary, the anterior interbody cervical fusion is used to treat most problems in the neck caused by degenerative disc disease. These include unrelieved neck pain and pressure on the nerve roots caused by bone spurs or a herniated disc.

The goal of spinal fusion is to stop the motion caused by segmental instability. This reduces the mechanical neck pain caused from excess motion in the spinal segment. The anterior cervical fusion may also be done in a way that spreads the vertebrae apart a bit, trying to restore the space between them. Increasing the distance between the vertebrae also makes the foramen larger in the back part of the spinal column. This may reduce the pinching and irritation of the nerve roots by bone spurs around the foramen.

Instrumented Cervical Fusion

When doing a cervical fusion, the bone graft may simply be wedged in between the vertebra. It is held there simply because it is wedged in tight. In recent years, there has been an increase in the use of metal plates, screws, and rods to try to increase the success of helping the spine to fuse. Many different types of metal implants are used; all try to hold the vertebrae in position while the fusion heals. Bone heals best when it is held still, without motion between the pieces trying to heal together. The healing of a fusion is no different than healing a fractured bone, such as a broken arm. However, the neck is a difficult part of the body to hold still.

In the past, casts and braces were used in an attempt to reduce the motion in the neck and to increase the success rates of a spinal fusion. In most cases, these braces and casts were simply too cumbersome to wear for three months, and did a poor job of actually holding the neck still enough to allow the fusion to heal.

In the cervical spine, the most common form of internal fixation is using a metal plate and screws. The plate sits on the front of the vertebrae and the screws go backwards into the vertebral body to help hold the plate in place and to help keep the bone graft from slipping out of place.

By using metal plates and screws, the vertebra can be held rigidly in place while the fusion heals. Braces and casts are not needed.

Cervical Fusion Recovery

You will awaken in the postoperative recovery area. Blood pressure, heart rate, and respiration will be monitored. Any pain will be addressed. Once awake, you will be moved to a regular room where you’ll increase your activity level (sitting in a chair, walking). Patients who have had bone graft taken from their hip may feel more discomfort in their hip than neck incision.

This surgery usually requires a short stay in the hospital. You may need to wear a brace on your neck (cervical collar) during recovery.

Cervical Fusion Possible Risks

Although cervical spinal fusion stiffens part of the neck, this does not reduce neck flexibility for most people.

Surgery and the use of anesthesia involve some risk. The risks associated with this procedure vary depending on your age and overall health, diagnosis, and type of procedure used.

Cervical Fusion Risks Include:

• Pain in a bone graft site (donor site).
• Failure of the fusion, breakage of metal implants (if used), or both.
• Blood clots in deep veins.
• Nerve or spinal cord injury.
• Graft rejection.
• Infection.
• Excessive bleeding.
• Risks of general anesthesia.