Cervical fusion is a surgery that can treat a wide variety of complex diseases beyond what disc replacement can achieve. The main goals are decompressing the nerves and spinal cord and stabilizing the neck in proper alignment. When fusing a segment, two mobile parts of the spine are connected together and then will slowly bridge together over time. This process halts arthritis, stops harmful motion, and can decompress the nerves but has the downside of halting normal motion at the segment as well.
While cervical disc replacement is a great technology for many patients looking for motion preservation, in some cases cervical fusion is still necessary to address more complex pathologies. Most patients that have focused cervical fusions do not notice much change in their range of motion. Some loss of range of motion is expected after a longer, multi-level fusion in cases of fracture, severe arthritis, or severe deformity.
Multilevel cervical fusion
Here a multilevel fusion is performed via an an anterior approach through a very small incision.
My surgeon told me they are making a cut in the back of my neck. Do I have to have a posterior fusion?
Regionally, posterior cervical approaches are common but these surgeries are very painful, morbid, and high risk. In most cases, a less invasive solution is available. See us and learn your Modern Spine options.
Cervical Fusion Procedure
Cervical fusion is performed from the front of the neck (anterior), the back of the neck (posterior), or in complex cases from both the front and the back (360). At Modern Spine, we favor anterior approaches over posterior ones because they are generally much better tolerated with less risk. Anterior surgeries of 2 or less levels are generally outpatient procedures but more levels usually require a short hospital stay. Anterior fusions are often called ACDF’s short for Anterior Cervical Discectomy and Fusion and are usually done through very small incisions.
Posterior surgeries often require more days in the hospital as they are more invasive in general compared to anterior surgeries. Posterior surgeries are call Posterior Cervical Fusions and generally involve larger posterior incisions.
Sometimes, surgeries must be performed from both the front and the back of the neck which is why they are called 360 degree cervical fusions. These are usually for failed fusions or complex spinal issues.
Anterior Cervical Discectomy and Fusion (ACDF)
The approach is from a small incision in the front of the neck. The disc and bone spurs are removed off of the nerves carefully using a microscope for the delicate work around the nerves and spinal cord. Once the pressure is alleviated, a spacer is placed where the disc used to be. It is not mobile but acts as a strut to restore some height and shape that the disc lost. A small plate may be used to secure the bones together.
A simple 2 level ACDF takes about 1 hour to complete and is generally well tolerated.
Posterior Cervical Fusion
Posterior cervical fusions involve making an incision in the back of the neck. The bones are exposed carefully and when needed, bone can be removed off the nerves carefully. Screws are then placed in the bones avoiding critical structures.
The posterior approach is generally more painful than an anterior approach but can be more useful from some patients based on their pathology. The recovery is longer usually due to the more extensive muscle work that is involved in these approaches.
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