What Happens During Neck Fusion

Neck pain is a common occurrence. The neck, also referred to as the cervical spine, contains seven vertebrae. Each of these vertebrae has discs between them that absorb shock and stabilize the spine. Outside of the spine are many muscles, ligaments, tendons, and cartilage that provide a range of motion and support.

The many intricate networks surrounding the spine can go wrong in a myriad of ways. Some injuries/problems that may result in neck fusion include:

• Sudden Traumatic Injury
• Degenerative Disc Disease

There are many solutions for neck pain, so it can be difficult to decide which treatment option is right for each patient. Many cases of neck pain go away on their own, especially small injuries that can heal without intervention.

When pain persists and begins to interfere with an individuals ability to complete normal tasks, doctors look for the underlying cause of discomfort. Neck pain can be assessed using a physical evaluation, but most doctors will order a series of imaging techniques such as an MRI or X-Rays to determine the source.

Spinal abnormalities are tricky because it can be difficult to diagnose the cause of pain. Many patients have been observed with conditions such as bone spurs, which can cause a lot of damage and discomfort, but report no symptoms. Because of this, doctors have to be extra diligent about finding the source.

The Necks Normal Range Of Motion

The cervical spine consists of a stack of seven vertebral bones that are connected from the base of the skull all the way down to the chest. Neck mobility, also referred to as the cervical spines range of motion, varies somewhat from person to person and depends on several factors, including:

• Shape and structure of vertebral bones and their facet joints
• Cushioning provided by discs between the vertebral bones
• Flexibility of surrounding muscles and ligaments

Watch Cervical Vertebrae Anatomy Animation

Cervical range of motion is typically measured in three planes: sagittal , coronal , and transverse . Studies do not perfectly agree on what is an average range of cervical motion, but the following is an estimate for point of reference:

• 60 degrees of flexion
• 75 degrees of extension
• 45 degrees of lateral flexion
• 80 degrees of rotation 1

• Neck Mobility After a Multilevel Cervical Fusion

The Benefits And Risks In Summary

As stated earlier in this article. There are patients who do very well with cervical fusion surgery. Some report 100% improvement some report close to 100% improvement. Others get some improvement and they are happy with that. As in any medical treatment, there has to be a realistic understanding of what the benefit may or may not be.

Here is an August 2020 paper published in the Journal of Orthopaedic Surgery and Research. It gives a surgeons view of the realities of fusion surgery:

For patients with two-level symptomatic adjacent segment disease, both anterior and posterior decompression and fusion were effective for improving the neurological function. For patients with radicular symptoms, Anterior Cervical Discectomy and Fusion surgery had less surgical trauma, better restoration of lordosis, and less postoperative neck pain, but a higher chance of recurrent adjacent segment disease. Posterior decompression and fusion was an effective surgical option for older patients with myelopathy developing in adjacent segments.

When you have fusion you can develop adjacent segment disease over the years and the challenges they bring are things to be considered when the first surgery is suggested.

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What Is The Evidence A Patient Has Atlantoaxial Instability A Past C2

Another paper presented in the March 2020 edition of the Journal of Craniovertebral Junction and Spine by the same group of neurosurgeons looked at patients who had symptoms related to cervical myelopathy and had a previous C2-C3 fusion and the presence of single or multiple level nerve compression of the subaxial cervical spinal cord attributed to degenerative spine.

In this study, the researchers examined seven adult males were analyzed who had long-standing symptoms of progressive cervical myelopathy and where imaging showed the presence of C2-3 fusion, no cord compression related to the odontoid process , and evidence of single or multiple level lower cervical cord compression conventionally attributed to spinal degeneration. The presence of C2-C3 fusion is an indication of atlantoaxial instability and suggests the need for atlantoaxial stabilization . Effects on the subaxial spine and spinal cord are secondary events and may not be surgically addressed.

What To Expect After Cervical Spine Surgery

YOU SHOULD REPORT ANY BREATHING DIFFICULTIES OR DRAINAGE FROM YOUR INCISION TO YOUR PHYSICIAN IMMEDIATELY. YOU SHOULD ALSO REPORT ANY FEVERS, CHILLS, NAUSEA, VOMITING OR NIGHT SWEATS TO YOUR PHYSICIAN.

Generally, after neck surgery, we keep you in the hospital overnight. You will have a drain in your neck that will be removed by our staff in the morning. In most cases, we will send you home the day after surgery, and we will ask you to keep the dressing on your neck for 48 hours from the surgery date.

IT IS NORMAL FOR YOUR NECK PAIN TO GET WORSE FOR 3-5 DAYS AFTER SURGERY. PLEASE TAKE YOUR MEDICATIONS AS INSTRUCTED DURING THIS TIME. STOOL SOFTENERS ARE ALSO ADVISED FOR THE FIRST 3 WEEKS AFTER SURGERY. ANY OVER-THE-COUNTER STOOL SOFTENER IS APPROPRIATE.

Steri-Strips will cover your incision. These are small rectangular bandages that remain on your incision for seven days. For example, if your surgery is on Monday, you should keep the Steri-Strips in place until the following Monday. IF YOU HAVE VISIBLE SUTURES YOUR DOCTOR WILL REMOVE THESE.

You can shower 24 hours after the drain is removed. Do not to take a tub bath, swim in a pool, or soak in a hot tub until given permission to do so by your physician.

You may experience some numbness and tingling underneath your chin or around your incision, and your incision may be very sensitive. You may also have some temporary swallowing difficulties or hoarseness of voice. This is all very common after surgery.

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Heres An Interesting Case Of Persistent Pain After A Cervical Fusion

I recently had the opportunity to evaluate and operate on a really interesting case. This is a man in his late 40s who had an anterior cervical discectomy and fusion 2 and 1/2 years ago. Prior to his operation, he had really severe right sided C7 pain. After his operation, even though it was done by an experienced surgeon and appeared to be done well, his pain persisted. Prior to coming to see me, he picked out this image on his pain diagram.

In my office, it was clear that he was really suffering from a C7 radiculopathy. He had pain all the way down his right arm to the back of his hand. He couldnt sleep at night, and he was basically stuck on pain pills. I really carefully reviewed his CT scan that was obtained after his fusion, and here is what I saw.

Strengths And Weaknesses Of The Study

Information about return to work is scarce for ACDF patients, and prospective randomized studies are lacking, as well as the use of a validated outcome measure. No previous study has investigated work ability after ACDF. The present study is the first prospective RCT investigating 2-year outcome and predictive factors regarding work ability. The weakness of the present study is that it was not designed for the WAI or WAS, but for the main outcome NDI therefore, individuals not of working age were included in the RCT, which reduces the number of individuals included in the present study.

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Patients Undergoing Acdf Commonly Receive High

In September 2019, researchers at Johns Hopkins University and the University of Virginia suggested in their research published in the Spine Journal that Patients undergoing ACDF commonly receive high-dose opioid prescriptions after surgery, and certain patient factors increase the risk for chronic opioid use following ACDF. Interventions focusing on patients with these factors is essential to reduce long-term use of prescription opioids and postoperative care.One of these factors was that some of these patients were already taking high dose opioid doses prior to surgery and continued to do so after surgery.

Surgical Recommendation For Degenerative Disc Disease May Not Address The Patients Real Problems Cervical Neck Ligament Damage

In neck and spine surgery, doctors focus on degenerative disc disease and its treatment, anterior cervical discectomy and fusion, and cervical decompression surgery to remove whole or part of the cervical vertebrae to allow space on compressed nerves and to fix the instability by fusing vertebral segments together. In the case of C1-C2 instability, these two vertebrae are fused posteriorly to limit their amount of movement. The goal is to limit pressure on the nerves.

However, it may limit motion to such an extent that patients become completely unable to move that portion of their neck. In addition, fusion operations can accelerate the degeneration of adjacent vertebrae as the motion in the neck is distributed more on these tissues.

In 2014 headed by Danielle R. Steilen-Matias, PA-C, we published these findings in The Open Orthopaedics Journal.

• The cervical capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Such pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions such as disc herniation, cervical spondylosis, whiplash injury, whiplash-associated disorder, post-concussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome.

When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae.

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Life After Spine Surgery: Do People Really Return To Work

People with back and neck problems want to get well, get their lives back, and get back to work. Physicians and other spine care providers focus on decreasing pain in an effort to get these people back into their full speed lives again. Usually, appropriate exercise and conservative care is all that is required. Occasionally, surgery may be required to reestablish full function.

Years ago, spine surgery developed a well deserved reputation for causing as much back pain as it helped. Rarely did surgery deliver as much benefit as it hoped. Over the past twenty years of my career, advances in our ability to diagnose and treat spinal disease have expanded dramatically. With the latest techniques, we are now able to get people back to work and back to life after spine surgery very reliably.

Expectations

• So what should workers expect from spine surgery?
• How long does it take to recover?
• How realistic is it that a person could return to work after spinal fusion?
• Can a person who has had multiple back surgeries ever work again?

Study of Workers – We studied 255 patients, all adults between age 19 and age 60, who were working full time prior to their lumbar surgery. Some had to stop working before surgery due to pain, but they had the capability to work and hoped to get back to work following surgery. Excluded from the study were patients who were retired, students, the unemployed, and any patients involved in a worker’s compensation claim or litigation of any sort .

How To Deal With Long

For many people living with severe neck pain and symptoms from a herniated disc, degenerative disc disease, or a pinched nerve, a cervical fusion is the final treatment option. The purpose of the surgery is to relieve pain, yet many people find themselves suffering from persistent or worsening pain in the weeks and months following the procedure.

When a cervical spine surgery fails meaning it doesnt deliver the expected outcomes the continued pain and symptoms are known as cervical post-surgery syndrome or failed neck surgery syndrome.

Learn how to recognize the signs and explore the treatment options available.

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Patient Demographics And Surgeon

A total of 36 patients who underwent a fourlevel ACDF at C3C7 were identified in the database 28 with a minimum of 12 months clinical follow-up were included in the analysis. Baseline PROMs for the variables of interest were available for 18 patients 16 had complete data sets and 2 patients had data sets with missing values. The mean age at surgery was 58.5 , ranging from 41 to 79 years. There were 15 males. Five patients were smokers. Fifteen patients were classified as ASA III and 10 ASA II. Of the 28 patients, 6 underwent a hybrid procedure with one level corpectomy. The mean operative time was 257 min and the mean estimated blood loss was 134 ml .

Table 1 Summary of baseline characteristics for patients undergoing four-level ACDF.

Figures and demonstrate two illustrative cases of patients undergoing four-level ACDF.

Figure 1

A 57-year-old female with longstanding history of neck pain. Over the past few years, she has also started to notice a gradual decrease in dexterity and numbness in her hands. T2-weighted sagittal and axial magnetic resonance imaging scans showed multilevel cervical stenosis at the interspace levels C3C7. The patient underwent a four-level ACDF at the levels C3C7 with excellent clinical outcome. At the last follow-up, lateral flexion/extension X-rays of the cervical spine showed good alignment and solid fusion across each disc segment.

Figure 2

Anterior Cervical Decompression And Fusion Surgery For Cervicogenic Headache: A Multicenter Prospective Cohort Study

• 1Department of Orthopeadics, Featured Medical Center of Chinese People’s Armed Police Forces, Tianjing, China
• 2Department of Orthopeadics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
• 3Department of Orthopeadics, Beijing 304th Hospital, Beijing, China
• 4Department of Orthopeadics, Spine Center, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China

Background: Cervicogenic headache has long been recognized as a referred pain deriving from pathological changes in the upper cervical nerves. However, previous clinical studies found that anterior lower cervical discectomy for the treatment of cervical myelopathy and/or radiculopathy can also help relieve associated headaches. To date, there is still a lack of large sample and prospective study to investigate the effect of anterior cervical decompression and fusion on CEH associated with cervical spondylosis.

Methods: A total of 656 patients with cervical radiculopathy and/or myelopathy were enrolled in three spinal centers. Among them, 221 patients who were diagnosed with CEH were collected in this study, and 204 completed a 1-year follow-up. The primary endpoint was headache intensity during a 12-month follow-up period measured by the numeric pain rating scale . The secondary outcome measures included headache frequency, headache duration, and the neck disability index .

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Surgical Correction Of The Cervical Spine Curve During Fusion Surgery Does It Help Why Doesnt It Help

We would like to point out again that some people derive great benefit from anterior cervical fusion surgery, again, these are the people we do not see. We see the people who had less than hoped for success.

In our non-surgical regenerative medicine injection techniques, we recognize that to help the patient who suffers from chronic neck pain, we must address and correct problems of the curvature of the cervical spine to achieve the best results. Surgeons also look at the curvature of the spine and its correction as a possible aid in helping their patients.

In December 2018 in the medical journal Therapeutics and Clinical Risk Management, surgeons asked: Is correction of segmental kyphosis necessary in single-level anterior cervical fusion surgery? Here is how they answered that question:

• They examined 181 patients who underwent single-level ACDF surgery.
• There were 32 patients in the non-correction of the curve group and 149 patients in the correction of the curve group.
• Surgical correction of segmental kyphosis in single-level cervical surgery contributed to balanced cervical alignment in comparison with those without satisfactory correction. However, the researchers could not demonstrate that the correction of segmental alignment is associated with better recovery in clinical outcomes.

Summary And Contact Us Can We Help You How Do I Know If Im A Good Candidate

Please see related articles:

• Ross Hauser, MD. Reviews of Diagnostic Imaging Technology for Cervical Spine Instability the diagnosis of cervical spine instability, the ability to get to the root cause of the patients problems is still perplexing to many health care providers.
• Dynamic Structural Medicine Ross Hauser MD Review of Treatments for Cervical Spine Instability. Without normal spinal alignment and movement, neurologic structures that travel through the neck are at risk. Once alignment, curve, or stability are compromised, the body starts making compensatory changes down the spinal kinetic chain and symptoms develop.

References:

This article was updated April 5, 2022

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Complexities Of Measuring Cervical Range Of Motion

There are many reasons that cervical range of motion measurements vary in the medical literatureboth for healthy and fused cervical spines. Some examples include:

While the specifics of cervical range of motion can be complicated, most fusion surgery patients can safely ignore those details and focus on regaining enough neck mobility to return to a high quality of life.

Can You Use A Heating Pad After Cervical Fusion

After cervical fusion, patients can usually resume driving around ten days after surgery. They should, however, avoid driving long distances and should limit their driving to short distances. Also, patients should not drive or lift anything heavier than fifteen pounds for the first two to three weeks after surgery.

Its crucial to know when to use heat or ice. Heat increases blood flow to the surgical site, which can exacerbate pain and swelling. Heat should only be used as a last resort for the first few days after surgery. However, it can be helpful for reducing stiffness in the neck and easing pain.

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