Cervical spinal fusion uses a combination of bone grafts and instrumentation to create extra stability in the levels of the upper spine, at the throat and/or neck. It generally is only part of a surgery, though there may be exceptions, and tends to accompany disc removal, or discectomy. This surgery will result in some small range of motion loss, involves a lengthy recovery period, and doesn’t always work completely. Still, many patients are made much more comfortable by it and recover very well.
Access to the spine is reached through the front, or anterior, of the throat or the back, or posterior, of the neck. Generally, one or more discs have been removed, and the cervical spinal fusion aspect of the surgery begins. This involves taking bone from a human donor, allograft, or directly from the patient, autograft, and placing it in the now empty areas of spine with special chemicals that may stimulate growth.
Instrumentation made of metals or other materials is also affixed to the spine to promote stability. On an x-ray, this looks like a series of plates and large screws. Many doctors feel this instrumentation is necessary for two reasons. The little pieces of bone placed in the spine take months to fully grow and create bony fusion between the spinal levels. Also, if the spine does not fuse, plates and screws continue to provide stability for the neck.
Depending on the surgical outcome, many people with an anterior discectomy and cervical spinal fusion go home from the hospital within a few days. Some patients feel that the difficult part is really from the time of surgery onward. Until about the fifth to six weeks, most patients must wear a hard collar at all times. At about the fourth to sixth weeks, patients also begin physical therapy to improve range of motion and work on muscle weakness. When the collar finally comes off, many people are able to return to work, provided it is not too physically demanding.
True cervical spinal fusion is not usually accomplished in six weeks, though some people may show beginnings of it. Certain patients, particularly smokers, don’t ever achieve fusion because nicotine retards bone growth. This may or may not cause complications.
Ongoing problems that might result from imperfect cervical spinal fusion are kyphosis, or a forward bending of the spine, neck pain, or development of new disc and compression problems in areas that surround the disc removal site. Doctors sometimes recommend a second surgery to try fusion again, and this might be one of the only times fusion doesn’t accompany discectomy. Alternately, surgery could be recommended to address new problems with the cervical spine, such as compressed nerves or new herniated discs.
Lost range of motion from a cervical spinal fusion depends on the number of spinal levels that were fused. A single level is unlikely to result in much appreciable loss, but multiple levels of fusion could have an impact on how well people can turn their heads. This is understandable because a flexible disc that allowed for movement has been replaced with bone. Physical therapy often helps people compensate for these losses, but it takes time.
Despite possible disadvantages, neurosurgeons and orthopedic surgeons who regularly perform cervical spinal fusion often report positive results for their patients. Most people needing this surgery are in extreme and unrelenting pain. Giving up a tiny amount of neck function to achieve relief seems like a fair trade-off for many patients, and people are also drawn to the high recovery rates associated with this surgery when it is performed by competent surgeons.