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Posterior Cervical Fusion Surgery

Introduction

Many neck problems are due to degenerative changes that occur in the intervertebral discs of the cervical spine and the joints between each vertebra. Other problems are the result of injury to parts of the spine or complications of earlier surgeries. The vast majority of patients who have neck problems will not require any type of operation. However, if the non-operative treatments fail to control your pain or problems, your spine surgeon may suggest a posterior cervical fusion to treat your neck problem.

The purpose of this information is to help you understand:

  • The anatomy of the cervical spine
  • The types of problems a posterior cervical fusion is used for
  • The rationale for performing a posterior cervical fusion

* What you can expect from this procedure

Rationale

Surgery is not necessary in every case. No one type of surgery works for every neck pain problem. Numerous surgical procedures have been designed to treat each type of neck pain. A posterior cervical fusion may be recommended for several reasons:

  • To stop the motion between two or more vertebrae – or spinal segments
  • To straighten the cervical spine and stop the progression of a spinal deformity
  • To stabilize the spine after a fracture or dislocation of the cervical spine

The goal of a posterior spinal fusion is to allow two or more vertebrae to grow together or fuse into one solid bone. If the operation is being done because you are suffering from mechanical neck pain, the fusion can stop the excess motion between the vertebrae caused by segmental instability. This can reduce your pain.

If your spine is unstable, due to a fracture or a dislocation of the vertebrae, the fusion stabilizes the spine. This is particularly important when you have not injured your spinal cord. Stabilizing the spine surgically can protect you from spinal cord injury during the healing process. Even in cases when there has been severe damage to the spinal cord leading to paralysis, a spinal fusion may be recommended, so that you can get out of bed and into a wheelchair faster. This allows early rehabilitation because the spine has been stabilized by the internal fixation.

A posterior cervical fusion may also be suggested to straighten the spine, or control a deformity of the cervical spine such as a cervical kyphosis. The cervical spine normally has a "C" shaped curve with the opening towards the back. A "kyphotic" curve is exactly the opposite – the opening of the "C" points forward. This deformity occurs when the cervical spine is unstable and begins to bend forward.

Procedure

This surgery is done through the back of the neck. A bone graft is placed on the back surface of the problem vertebrae. During the healing process, the vertebrae grow together, creating a solid piece of bone. This type of fusion is used in the cervical spine for fractures and dislocations. It is also used to correct deformities in the neck.

The goal of spinal fusion is to stop the motion caused by segmental instability. This reduces the mechanical neck pain caused from too much motion in the spinal segment.

You may also hear the term anterior fusion. This procedure is commonly used to treat neck problems. The surgeon works from the front (anterior) of the neck. A bone graft is placed between two vertebral bodies (interbody area) to replace the disc that normally sits between them. During the healing process, the vertebrae grow together, creating a solid piece of bone. Learn more about the use of bone graft.

Instrumented Posterior Cervical Fusion

A graft that is held tightly in place has a better chance of fusing the vertebrae together. To improve fusion, doctors commonly use metal plates, screws, and rods. These implants are referred to as instrumentation. Many different types of metal implants are used with the intent of maximizing healing of the fusion.

Bone heals best when it is held still-without motion between the pieces trying to heal. The healing of a fusion is no different than healing a fractured bone, such as a broken arm. However, the neck is one part of the body that is difficult to hold still, even with a brace worn around the outside of the neck. Wearing a brace for several months after the surgery can be uncomfortable.

When instrumentation is used to improve the success of a posterior fusion, metal rods or plates are attached to the bone structures in the back of the spine. Stainless steel or titanium cables can also be used. When doctors use this type of instrumentation, a brace may only be needed for a short period of time, or not at all.

After Surgery

What happens after surgery?

Most patients are placed in a rigid neck brace after surgery for several months. These restrictive measures may not be needed if the surgeon attached metal hardware to the spine during the surgery.

Patients usually stay in the hospital after surgery for up to one week. But they can start to get up as soon as they feel up to it. Patients are watched carefully when they begin eating. They usually drink liquids at first. If they are not having problems, they can go on to solid food.

A physical therapist will schedule daily sessions to help patients learn safe ways to move, dress, and do activities without putting extra strain on the neck.

Patients are able to return home when their medical condition is stable. However, they are usually required to keep their activities to a minimum in order to give the graft time to heal. Outpatient physical therapy is usually started four to six weeks after the date of surgery.