Introduction
Cervical spine fusion, also referred to as 'arthrodesis', is a procedure to 'fuse' or join two bones together to prevent that joint from moving independently. Cervical spine fusion can be performed from the front of the spine – Anterior Cervical Discectomy and Fusion (ACDF), or back of the spine – Cervical Laminectomy and Lateral Mass Fusion. On rare occasions, fusion may need to be performed using both front and back approaches.
Indications
A cervical spine fusion may be required to treat the following conditions…
- Spinal stenosis – causing myelopathy.
- Disc prolapse – causing myelopathy or radiculopathy.
- Arthritis and degenerative changes.
- Tumour / infection.
- Spondylolisthesis (misalignment of vertebrae).
- Spinal deformities.
- Injury / trauma (where the neck must be stabilised to prevent damage to the spinal cord).
In some cases, a cervical spinal fusion is a 'last resort' where other approaches have not been able to minimise pain sufficiently.
Preoperative Instructions
Before all neurosurgical procedures, including the procedure for cervical spinal fusion, you should…
- Stop having anything to eat or drink from midnight the night before the procedure. (You can still take your usual medications with small sips of water).
- Please advise us if you take blood thinners (aspirin, Plavix, warfarin or other blood thinners) as you may need to stop taking them a few days ahead of the procedure.
- Check if non-steroidal anti-inflammatory medication (NSAIDs) may need to be stopped one to two weeks ahead of the procedure.
- As much as possible, avoid dental treatment (within three weeks) or any other form of surgery (within three months) of the planned procedure.
- If you develop any symptoms of infection, e.g. a cold or flu, before surgery, or if you are receiving treatment for an infection, please alert our office as soon as possible.
Procedure
The procedure may be performed either to the front of the vertebra (anterior) or to the back (posterior) or as a combination of the two approaches.
With front or anterior fusion, the disc material is removed, and replaced with either a bone from another part of the body (generally from the pelvis) or an artificial cage containing bone graft or synthetic bone may be used instead of a bone graft. The new material may simply be 'wedged' between the remaining vertebrae, although the use of metal implants (plates, screws and rods) to fix the graft in place will help the fusion process occur.
With back or posterior fusion, a cervical laminectomy is performed, but screws and rods are placed in the bones on the sides of the vertebra, called lateral mass or facet joints. Bone graft is placed next to the screws to help with the fusion process.
Postoperative Instructions
A cervical spinal fusion procedure normally requires a hospital stay of 3-4 days, although this may be longer if the surgery has been extensive. There is a relatively long period in which the bone is healing when activity must be limited. Full bone recovery normally takes 3-4 months.
Although not necessary in every case, you may need to wear a neck brace to stabilise the spine. Rehabilitation (from around week 4 after the operation) will also involve neck strengthening exercises and aerobic conditioning – an individualised program is put together for all patients.
Risks
The following complications are not common, but can occur after a cervical spine fusion…
- General risks associated with surgery / anaesthesia.
- Nerve injury.
- Spinal cord injury.
- Bone graft issues, such as infection, rejection, fusion not occurring.
- Failure of metal components (if used).
- (With ACDF) Injury to surrounding structures, such as carotid artery and oesophagus, resulting in difficulty swallowing, or a stroke.
Treatment Alternatives
Other treatments include pain medication and physiotherapy if symptoms are mainly pain-related. Corticosteroid injections may also help with nerve pain.