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You may have one or more damaged discs in your neck. Discs are rubbery shock absorbers between the vertebrae, and are close to the nerves which travel out to the arms. If the disc is damaged, part of it may bulge or even burst free into the spinal canal, putting pressure on the nerves and causing arm pain, numbness, weakness and/or pain in the neck or shoulder area. Occasionally, this pressure may affect the spinal cord and cause abnormalities in the legs or lower parts of the body. Bone spurs, usually the result of arthritis, can also put pressure on nerves or the spinal cord. Loss of the normal “shock absorber” function, or arthritis around the damaged disc, can also produce mechanical pain around the neck or shoulders with neck movement or awkward positions.
The best approach to your problem is to remove the damaged disc and bone spurs from the front, or anterior part, of the neck and to perform a fusion between the adjacent vertebral bodies. Certain conditions, however, require the surgeon to perform the fusion using a posterior approach instead.
A fusion is a bony bridge between at least two other bones, in this case two vertebrae in your spine. The vertebrae are the blocks of bone which make up the bony part of the spine, like a child’s building blocks stacked on top of each other to make a tower. Normally each vertebrae moves within certain limits in relationship to its neighbors. In spinal disease, the movement may become excessive and painful, or the vertebrae may become unstable and malaligned, putting pressure on the spinal nerves. In cases like this, surgeons try to build bony bridges between the vertebrae using pieces of bone which we call bone graft. The bone graft may be obtained either from the patient himself, usually from the pelvis, or from a bone bank. There are advantages and disadvantages to either source. The bone graft is laid between the vertebrae. The bone graft has to heal and unite to the adjacent bones before the fusion becomes solid. Spine surgeons often use plates to protect the bone graft and stabilize the spine during the healing period, attaching them to the spine using screws.
An incision, usually about two inches in length, is made across the front of the neck. The windpipe, esophagus (food pipe) and other tissues are temporarily pushed aside and the abnormal disc or discs are removed completely. If your own bone is to be used for the fusion, another small incision is made over the front of the pelvis and one or more small bone grafts are removed to replace the disc or discs. In most cases this bone will heal or “fuse” to the vertebrae above and below it within six to nine months, creating a solid bony bridge between the two vertebrae and eliminating movement between them. For fusions involving more than one level, or in the case of unusual spinal instability, internal plates and screws may be used to improve stability and conditions for bone healing.
In most cases, the major indication for spine surgery is pain. Weakness, numbness, clumsiness, and gait instability may also be an indication for surgery. Often non-surgical measures can control the pain satisfactorily. You may be referred to physical therapy. You can schedule an appointment with our outpatient physical therapy by calling 732.557.3283. If the pain persists and interferes with daily activities or if other neurologic problems develop, then surgery may be necessary to relieve the problem. In most cases, the patient makes the final decision about surgery because of pain. If neurologic damage is occurring, your doctors may strongly recommend that you proceed with the operation.
Most patients leave in 24 hours; however, anterior/posterior cervical fusion patients will be in the hospital for 2-3 days.
Rarely do we need to give a transfusion. Only in rare tumor or unusual reconstruction cases will a transfusion be needed.
You should try to walk and take care of yourself as much as you are able to. You should try to exercise each day. You may perform other low-impact activities not requiring lifting or neck movement as allowed by your brace. If a brace is not required, you may drive when allowed by your surgeon.
You should avoid lifting heavy objects, and avoid all overhead lifting. Twisting, repetitive bending and tilting your head back to look overhead are also stressful to the neck. If you are a smoker, you definitely should not smoke until your fusion is completely solid. Smoking interferes with bone healing.
Most patients will wear some type of neck brace after this surgery. The type of brace and length of time you need to wear the brace will be determined by your surgeon.
That depends on the type of work you do. If a brace is required, you will not be able to drive until you no longer need the brace. For sedentary jobs, work may resume when you feel comfortable and can get to work. For jobs which require more strenuous physical exertion, a longer healing time may be required. Your surgeon will discuss this with you individually.
80-95 percent of the patients obtain relief from their arm pain. Relief of neck pain is less predictable, usually in the range of 65-75 percent.
No. While most patients have excellent relief of arm pain after surgery, your neck will not be completely normal. While most patients with a one or two-level fusion will not notice significant loss of motion, the stiffened segment of your spine does put additional
stresses on adjacent discs, which may already be abnormal to some extent. These other discs may cause symptoms. Although most patients can resume most of their normal activities after healing, you should take care of your neck. Your surgeon can discuss this with you in detail.
The chance of neurologic injury with spinal surgery is low, but not impossible. Injury to a nerve root with isolated numbness and/or weakness in the arm is possible. Fewer than one in 1,000 cases may result in paralysis, either complete or partial.
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Frequently Asked Questions about Cervical Fusion
