Cervical Spine Fusion
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Key Takeaways
- Cervical spine fusion is a surgical procedure to treat conditions affecting the vertebrae in your cervical spine.
- The procedure involves fusing two vertebrae to form a single, solid bone, thereby treating damage to the vertebrae and supporting the stability and flexibility of the cervical spine.
- Cervical spine fusion can be performed using several approaches, informed by the nature of the injury or degeneration.
- Recovery typically takes between six months and a year for the fused bone to solidify. Proper care is necessary to facilitate recovery and minimise the risk of complications.
What is Cervical Spine Fusion?
Spinal fusion is a surgical procedure used to manage conditions affecting your vertebrae, the small bones that make up your spine. Cervical spine fusion focuses on treating the cervical spine, which is located in the neck region. The process aims to fuse two or more injured vertebrae, allowing them to heal as a single, solid bone. Cervical spine fusion is commonly recommended for conditions such as arthritis, which can affect the spine’s stability and lead to discomfort.
The primary treatment goal of cervical spine fusion is to minimise or eliminate movement between vertebrae when it is a source of pain and discomfort. While the fusion process does reduce some spinal flexibility, the procedure does not substantially mitigate your cervical spine’s range of motion. Other surgical procedures may also be performed to treat, such as impinged spinal nerves leading to arm or leg pain.
When is Cervical Spine Fusion Recommended?
Cervical spine fusion may be recommended to relieve symptoms of multiple conditions affecting the cervical spine.
Fractured Vertebrae
Trauma to the cervical spine can cause a fracture, which can be painful when you move your neck while also increasing your risk of spinal instability. Cervical spine fusion will fuse the damaged vertebrae as a single, solid bone to stabilise the fractured vertebrae.
Spinal Stenosis
Gradual wear and tear can narrow the spinal canal (which houses the spinal cord and nerves), increasing the risk of nerve impingement and pain. Cervical spine fusion may be performed to stabilise the spine and minimise further narrowing of the spinal canal.
Degenerative Disc Disease
This condition is characterised by the gradual degeneration of the intervertebral discs, which help to support the spine. Degenerated discs cause friction between the vertebrae, which can then lead to conditions such as scoliosis (abnormal spinal curvature) or a slipped disc. Spinal fusion will first remove the degenerated disc and fuse two vertebrae to maintain spinal stability and alleviate symptoms.
Herniated Disc
Also known as a slipped disc, a herniated disc occurs when an intervertebral disc tears or leaks material onto the spinal cord due to injury, gradual wear and tear, or degeneration. The leaked material presses onto nearby spinal nerves, causing pain, numbness, and weakness. Treatment is similar to that of degenerative disc disease, in that the herniated disc is first removed before spinal fusion can be performed to alleviate symptoms.
Spondylolisthesis
This condition occurs when a vertebra slips forward and out of place from the spinal column. The condition increases your risk of spinal instability, causes pain and discomfort, and may accelerate the progression of arthritis. Spinal fusion aims to fuse the slipped vertebra to a healthy one to restore the cervical spine’s stability and flexibility.
Types of Cervical Spine Fusion
There are three main approaches to cervical spine fusion, depending on which vertebrae need to be fused.
Anterior Cervical Discectomy and Fusion (ACDF)
ACDF is the most common surgical approach for cervical spine fusions, which approaches the cervical spine from the front (anterior). The surgeon will make an incision at the front of your neck to reach the cervical spine and perform the necessary surgical procedures. Debris such as loose bone fragments and bone spurs will also be carefully removed via the anterior incision.
Posterior Cervical Fusion (PCF)
PCF is the opposite of ACDF, where the procedure is performed via an incision at the back of your neck. Small portions of your vertebrae will need to be carefully removed, while the surrounding nerve roots are gently moved aside to enable surgery to take place.
Combined Anterior and Posterior Approach
If it is necessary to fuse and stabilise several cervical vertebrae simultaneously, your doctor may recommend a combined approach. You will need to be flipped over during the surgery so that the surgeon can access both sides of your cervical spine.
Minimally Invasive Approach
This approach uses smaller incisions and a less invasive surgical technique than conventional open surgery. It allows surgeons to access the cervical spine area while aiming to limit disruption to nearby muscles, tissues, and nerves. This approach may be recommended for mild to moderate cases that do not require extensive surgery to perform a spinal fusion.
How is Cervical Spine Fusion Surgery Performed?
Your doctor will first evaluate your condition via a physical examination. They may assess your cervical spine’s mobility and flexibility, as well as identify signs and symptoms that may suggest the need for cervical spine fusion. Diagnostic tests are also performed to confirm the diagnosis and enable the selection of the appropriate surgical approach. Additional information and advice will be provided to help you prepare for your surgery.
A bone graft may be prepared before or during your surgery. It is used to stimulate bone healing and to allow spinal fusion to heal the damaged vertebrae into a single bone. The graft may be taken from your pelvis (autograft) or from a deceased donor (allograft), though artificial bone grafts are also available.
Before the procedure, you may be administered a local or general anaesthetic to put you to sleep throughout the surgery. Once you are sedated, the surgeon will make an incision along your neck, its position determined by the chosen surgical approach (anterior, posterior, minimally invasive). Your breathing tube (trachea) and the swallowing tube (oesophagus) may also need to be moved aside. Once they can access your cervical spine, your surgeon will carefully remove bone fragments, bone spurs, or damaged disc(s) as required. They will also remove anything that is impinging on nearby nerves or the spinal cord itself.
After this process, the spinal fusion procedure can begin. The surgeon will place the bone graft in the space where the removed disc(s) were initially positioned. The surgeon will then perform internal fixation using implants, such as plates, screws, or rods, to stabilise the vertebrae during healing. They will then carefully reposition your internal structures (i.e., the oesophagus) and close the incision site.
When you wake up, you may need to remain in the ward for a few days for observation. You may be prescribed medications as part of your post-surgery care, and a neck brace is advised to be worn daily to protect the healing area.
Recovering from Cervical Spine Fusion Surgery
It may take between 6 months and 1 year for the fused bone to solidify, though this may vary from person to person. You will need to always maintain proper posture to facilitate recovery. To keep it in alignment, you will be taught how to move, stand, sit, and walk properly to minimise complications. Light physical activity is allowed, but avoid overexertion by not placing pressure on your neck.
You may still experience some degree of pain and discomfort, so abide by your doctor’s post-surgery care instructions. Be sure to take your prescribed medications at the scheduled times to manage your pain effectively. The pain will gradually subside on its own, but notify your doctor immediately if your pain levels persist or worsen.
Physical therapy can begin approximately six weeks to three months after the cervical spine fusion procedure, or when your doctor decides you can start your first session. You can discuss your physical therapy needs with a qualified physiotherapist, who will assess your recovery and recommend exercises to help you progress at a comfortable pace.
If your recovery progresses well, you can return to work three to six weeks after your surgery. This may depend on your overall recovery and your job’s general demands. You may resume your regular activities within 3 to 4 months after your surgery.
Frequently Asked Questions
Is the cervical spine fusion procedure permanent?
Yes, the use of a bone graft and internal fixation aims to ensure the vertebrae can fuse and preserve the cervical spine’s stability while reducing the risk of complications. The implants used to hold the bone graft and vertebrae together are typically left in permanently.
Do I lose any flexibility after a cervical spine fusion?
Due to the nature of spinal fusion, you may lose some degree of flexibility in your neck. Physical therapy and good posture may help to support your neck’s alignment and gradually restore its flexibility during your recovery. You should be able to resume your regular activities after recovery, depending on your healing progress.
Are there any risks to cervical spine fusion?
As with any surgery, there may be some risks associated with the procedure, and your doctor will discuss them at length before your surgery. Potential risks and complications may include infection, blood clotting, persistent pain at the surgical site, and nerve damage. Following your doctor’s post-surgery care instructions is essential to support recovery and reduce the risk of future complications.
Related Treatments
Cervical discectomy is a surgical procedure that removes a damaged or herniated disc in the neck (cervical spine) to relieve pressure on spinal nerves. During the surgery, the affected disc is removed through a small incision, and a bone graft or implant may be used to stabilise the spine. This treatment helps reduce neck pain, stiffness, and nerve-related symptoms such as arm pain or numbness, allowing better neck mobility and long-term relief.
Anterior Cervical Diskectomy and Fusion (ACDF) is a spine surgery that removes a damaged or herniated cervical disc to relieve nerve compression, then inserts a bone graft to fuse the affected vertebrae and stabilise the neck.
