Cervical Fusion

This operation is often performed together with a discectomy. There may be reasons, however, to perform a fusion alone.

Who needs it?

Patients with severe neck pain which is secondary to instability of the spine, or who are suffering from severely painful discs AND who have been treated with other non-surgical techniques and have failed to improve, may be candidates for fusion surgery.

How is it done?

The cervical spine may be approached from the front, when the fusion is combined with a discectomy or behind. An anterior fusion involves removal of one or more discs, insertion of bone graft or a suitable spacer into the disc space, to maintain the disc height and allow bone to grow across the gap and, usually, the application of a small plate to the front of the spine to hold it together until the bone has healed.

The plate fixes the bones together

A posterior fusion requires retraction of the large muscles at the back of the neck, often quite painful post-operatively, and insertion of screws into the bones, which are joined together with a plate or rod system. Bone graft is also positioned alongside and it is this which ultimately fused one vertebra to another.

The bones, and, here, the skull, are secured with a screw and rod system

What are the risks?

The biggest worry is trauma to the spinal cord. This is said to occur in one percent of operations per level being fused (i.e. a three level fusion may carry a risk of 3%). This may cause paralysis or weakness which may improve in time, but may not. 

The nerve roots behind the disc may potentially be damaged by the surgery or bleeding causing a build up of pressure. The structures in the neck including the trachea, oesophagus and blood vessels are at risk. There is a small nerve, the recurrent laryngeal nerve, which runs in the groove between the trachea and oesophagus, which if damaged, may lead to vocal cord paralysis on the affected side. This may require treatment from a throat specialist or may resolve spontaneously.

The late risks include the possibility that the fusion will not heal, leading to a return of the pain the patient previously suffered, or that the bone graft will collapse, still fusing, but in a flexed posture. This latter is often prevented by inserting a metal plate over the bone graft.

Recovery

Most patients recover quickly from anterior fusions and are ready to leave hospital within two or three days. Posterior fusions may be more painful and therefore require a longer stay. Most patients are supplied with a soft collar to wear for the first six weeks, to prevent excessive movement and remind the patient that they are healing!

Back to Surgery