Cervical Spinal Fusion Surgery

The cervical spine is the neck region of the spinal column. It consists of seven bones (C1-C7 vertebrae) with intervertebral discs in between each of them that allow the spine to move and act as shock absorbers during activity. The vertebral bones form the spinal canal, a hollow longitudinal space that runs the whole length of the back through which the spinal cord and nerve bundles pass. Other structures in the neck include muscles, nerves and joints.

Neck pain refers to any discomfort in any part of the neck. For some people, neck pain may radiate down one or both arms. Acute neck pain is common and usually disappears within one to two weeks. However, neck pain may recur after certain activities, such as after a long day at work or intensive sports. A person has chronic neck pain if the symptoms last over three months. Strain or tension is the most common cause of neck pain, but there are cases with no apparent cause. An active lifestyle and daily exercise that targets the neck can help prevent neck pain.

Causes

Everyday activities may cause neck pain, such as:

• Bending over a desk for hours
• Having poor posture
• Working on a computer monitor positioned too high or too low for a long time
• Sleeping in an awkward position
• Twisting and turning the neck in a jarring manner while exercising
• Lifting things too quickly or with poor posture
• Being exposed to a cold draft

Accidents or falls can cause severe neck injuries, leading to paralysis for some people. Other causes of neck pain are:

• Jaw joint problems or severe headaches
• Conditions that arise from wear and tear (degeneration) on the cervical spine, such as osteochondrosis and cervical spondylosis or osteoarthritis of the joints between the neck vertebrae
• Whiplash due to a road accident, which occurs when the impact of the collision causes the head to jerk forward and then back again rapidly
• Narrowing of the vertebral canal, or a slipped disk, causing the spinal disk tissue to bulge or leak out and put pressure on a nerve root
• Herniated discs and bone spurs
• Blood vessel destruction
• Medical conditions, such as fibromyalgia
• Small fractures to the spine from osteoporosis
• Spine infections, such as osteomyelitis, diskitis or abscesses
• Torticollis
• Cancer or meningitis in rare cases

Treatments

Although neck pain can be debilitating and painful, most cases of neck pain are not life-threatening and resolve on their own or with conservative medical treatments for pain relief for about six to eight weeks.

Nonsurgical Treatments

For minor, common causes of neck pain:

• Take over-the-counter medications to reduce pain or inflammation and muscle relaxants as prescribed by your doctor.
• Reduce physical activities that strain the neck or back for the first few days.
• Wear a cervical collar to help support the spine, reduce mobility and decrease pain and irritation. However, using a collar for a long time can weaken the neck muscles. Make sure to take it off occasionally to help strengthen the muscles.
• Apply ice for the first 48 to 72 hours and heat to the affected area afterward.
• Take warm showers to help loosen up tight muscles in the neck and shoulders.
• Sleep on a firm mattress with a pillow that supports the neck.

Surgery

Spine surgery is only considered when nonsurgical medical treatments do not work and the doctor can pinpoint the specific source of the patient's pain. Imaging tests, such as X-rays, computed tomography (CT) scans and magnetic resonance imaging (MRI) scans help find the cause if there are signs of serious disease.

What Is Spinal Fusion?

The basic idea of spinal fusion is to weld or fuse two or more vertebrae so that they heal into a single, solid bone to correct problems with the small bones in the spine. Spinal fusion helps eliminate painful motion between vertebrae or restore spine stability. The procedure allows spine surgeons to remove bone and diseased tissues that are putting pressure on the spinal nerves.

What Is Cervical Fusion?

Cervical spinal fusion surgery is a common neck surgery that fuses two or more vertebrae to create a single, solid, stable piece of bone. Spine surgeons use various devices, such as metal screws or plates, to hold the fused vertebrae and support unstable cervical spine areas. Cervical spinal fusion surgery is recommended for severe cervical fractures or as a surgical treatment for a pinched nerve or compressed spinal cord.

Several techniques or approaches exist to perform cervical spinal fusion surgery. Spine surgeons can reach the spine from the front, which is called an anterior approach and involves an incision at the front of the neck. All spinal fusions use bone grafting to enhance fusion and stimulate bone healing. Bone grafting involves placing small pieces of bone into the space between the vertebrae for fusion. Bone grafts can be harvested from the patient's pelvis or a donor.

What Are the Symptoms of Needing a Cervical Fusion?

A person may be a candidate for cervical spinal fusion surgery if:

• Conservative medical therapy fails to treat the symptoms
• There is a decreased function due to chronic and persistent neck pain
• There are progressive or worsening neurological symptoms involving the arms and legs
• There is difficulty with balance or walking

When Is Cervical Spinal Fusion Necessary?

Some of the most common conditions that may be necessary to perform cervical spinal fusion surgery include the following:

• A pinched nerve (cervical radiculopathy) – is a condition that occurs when there is excess pressure placed on one of the nerve roots in the neck
• Spinal cord compression (cervical myelopathy) – results from a compressed or irritated spinal cord. Osteoarthritis, scoliosis or an injury to the neck are some of the most common causes of cervical myelopathy.
• Broken neck (cervical fracture) – a condition that occurs when one or more of the bones in the neck is broken

How Long Is Recovery for Cervical Spine Surgery?

Unlike lower back surgeries, neck surgeries often require only a day or two in the hospital following surgery. Pain after cervical spinal fusion surgery is a natural part of the healing process. Your doctor will likely prescribe medications for short-term pain relief after surgery, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs) and local anesthetics. You may perform light activities or exercises like walking but may not be allowed to work, drive, or lift heavy objects immediately after surgery. Ask your doctor when you can safely resume your normal daily activities.

Spine surgeons typically recommend physical therapy six weeks to three months after surgery to restore their patients' strength and range of motion in the neck. The total recovery time for cervical spinal fusion surgery varies, but the fusion process usually takes between six months and a year before the bone completely solidifies. Cervical spinal fusion may affect spinal flexibility, but spinal fusions involve only small segments of the spine and do not limit motion very much.

As with any procedure, neck surgery has potential risks and complications, so it is vital to carefully weigh your options and discuss the advantages and disadvantages of surgery with your spine surgeon before deciding to pursue surgery.