Cervical Spine Fusion

Your spine consists of a spinal cord supported by a series of interlocking bones called vertebrae. The cervical spine is the upper part of the spine situated in the neck region. It has seven vertebrae, separated and cushioned by spongy intervertebral discs. The vertebrae and discs may get damaged by injury, disease or wear-and-tear, compromising the cervical spine. Cervical spine fusion is a surgery performed to fuse weak cervical vertebrae with adjacent vertebrae to provide stability and prevent injury to the spinal cord.

A cervical spine fusion may be indicated to stabilize injuries and prevent fracture and spinal cord damage, and to treat misalignment of the vertebrae, herniated discs, arthritis, tumor, deformities and infection.

Different techniques may be used to fuse cervical vertebrae. The surgery is performed under general anesthesia. An incision may be made on the front or back of your neck, and muscles and tissues separated to expose the damaged vertebrae. The entire vertebrae or the spinal disc may be removed and the adjacent bones fused. Your surgeon may take bone graft from another part of your body or use an artificial bone material and place it in between the vertebrae to form a bridge and stimulate new bone growth. The vertebrae may be stabilized by metal implants or plates and screws while new bone grows.

You may experience slight stiffness of the neck as a result of cervical fusion, but it doesn’t compromise the flexibility of the neck. As with all surgical procedures cervical spinal fusion may be associated with certain risks such as graft rejection, failure to fuse, nerve injury, bleeding and infection. Overall, however, the procedure has good results and can often treat pain, prevent paralysis and provide stability to the neck.

Posterior Cervical Fusion

Posterior cervical fusion (PCF), a surgical procedure performed through the back of the neck, involves joining or fusing two or more damaged cervical vertebrae. The fusion of vertebrae is also known as arthrodesis. Sometimes metallic plates may be used for fixing the vertebrae, this is also known as instrumentation.

PCF may be employed for the management of cervical fractures, bone dislocations, and deformities due to abnormal curvature of the cervical vertebrae.

Procedure

The basic steps of posterior cervical fusion include:

• The procedure is conducted in an operating room with the patient under general anesthesia.
• The patient lies face down, on the operation table.
• A small incision is made over the middle of the neck, at the back.
• The muscles and the soft tissues are then retracted to approach the spine.
• X-ray imaging is employed to identify the affected intervertebral disc.
• The surfaces of the lamina of each vertebra to be fused are trimmed. This results in bleeding which aids in rapid healing of the fused bones.
• In addition, small strips of bone graft taken from the pelvis are placed over the spinal column, which aid in fusion of the bones.
• Confirmatory X-rays may be taken to confirm the proper placement of the bone graft.
• Finally, the retracted muscles and soft tissues are placed in their normal positions and the wound is sutured.

Postoperative care

Patients may be discharged from the hospital within a week of the surgery. A neck brace is recommended for several months, however this restriction may not be required if the vertebrae are fixed with a metal plate during the PCF surgery. Patients are initiated on a liquid diet which is gradually changed to solid food, depending on their recovery.

Physical therapy is recommended after 4-6 weeks of the surgery. Physical therapists help patients perform their routine activities without exerting any extra stress on the neck. Rest is advised as it helps in healing of the bone graft.

Risk and complications

Every major surgery is associated with complications. Some of the complications associated with posterior cervical fusion include:

• Complications related to anesthesia
• Conditions such as thrombophlebitis
• Non-union or pseudarthrosis
• Infection
• Damage to the spinal nerves
• Problem related to bone graft
• Persistent pain