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Cervical Fusion Surgery at Our Los Angeles Center

Cervical spine surgery fuses one or more joints in the upper spine and is designed to relieve pain and other symptoms of nerve dysfunction from compression and chronic irritation. The goal of surgery is to immobilize the area of the neck that presses on the nerve roots when the spine flexes. Ideally, only one disc space in the neck will be fused, joining two vertebrae firmly together into a single unit. This approach has the highest chance of relieving symptoms without causing mobility and stability problems in the rest of the neck.

Who Is a Candidate for Cervical Spine Surgery?

Minimally invasive cervical fusion is designed for patients who have:

  • Ongoing, severe neck pain
  • Pain that radiates into one or both arms or hands
  • Significant weakness in the arm or hand
  • Any of the above symptoms that gets progressively worse

 

Most of the problems listed above respond to non-surgical treatments within a month or two. Very few patients end up needing surgery. There are a number of diagnostic tests such as x-rays, CT scans and MRI scans that can help determine whether a patient has a cervical spine disorder that may be alleviated by fusion.

Medical conditions that may be treated using cervical fusion and related cervical spine surgeries include:

  • Bulging or herniated disc
  • Degenerated disc
  • Slipped disc
  • Trauma (such as a fracture or other injury)
  • Spinal instability
  • Cervical radiculopathy (radiating pain)

 

Procedure Overview

A discectomy is often done along with the fusion if damaged or diseased discs are a contributing factor causing the patient’s symptoms. The disc is removed, leaving a gap. The bone graft that stimulates fusion of the two vertebrae is placed where the disc used to be. In this case, an anterior cervical fusion (ACF) is performed. This means the incisions are made in the front of the neck because the discs are easiest to access from this direction. If the fusion will be done on the sides of the vertebrae and the disc will be left in place, a posterior approach (through the back of the neck) may be used instead.

In the ACF surgery with discectomy, a small incision (about one inch) is made on the neck near the front on the right or left side. The incision continues through a thin layer of muscle. The internal structures such as the esophagus and trachea are gently moved aside to reveal the spine. The layer of membrane surrounding the spinal column is cut through to provide access to the disc. A needle is inserted into the treatment area and x-ray images are used to ensure that the needle is in the correct space in the spine.

Instruments are introduced into the spinal space via an endoscope (a small metal tube with fiber-optic light and tiny camera) that replaces the needle. The damaged or diseased disc is removed from between the vertebrae along with any bone spurs and other tissue that is pressing on the nerves. A bone graft is placed in the empty space left by the discectomy. This bone graft material may be harvested from the patient’s hip, taken from a donor bank or constructed from artificial substances that will be overgrown with the patient’s own bone tissue during healing. A disc-shaped bone graft may be pressed into the space where the disc was removed. The graft may be held in place by titanium screws and rods to ensure it does not shift out of place before fusion occurs.

Risks, Side Effects and Benefits

Spinal surgery carries some rare but serious risks of nerve damage, extensive bleeding, blood clots, spinal instability, anesthesia reactions and infection. Patients who are in good physical health, who do not smoke and who follow pre- and post-operative instructions may minimize their risk of complications. This surgery may not be a permanent solution to neck and arm pain as well as muscle weakness. The degenerative conditions that lead to the need for surgery may go on to affect other vertebrae over time, causing symptoms to recur.

Patients typically wear a neck brace in the days and weeks following surgery. Walking is encouraged, but bending, twisting and lifting are delayed until later. There is some discomfort and soreness after surgery that can be managed with pain medications. This discomfort should get better gradually. Mobility and strength are restored through physical therapy exercises starting at about 12 weeks when the fusion is well underway. It may take three to six additional months for the bone to finish fusing. Many patients who undergo minimally invasive cervical fusion can return to light work within a week or two. More vigorous activities must wait until the vertebrae are fully fused.

The benefits of minimally invasive cervical spine surgery may include:

  • Less bleeding during surgery
  • Less trauma to surrounding tissues
  • A more comfortable recovery
  • Less reliance on pain medication
  • Faster return to daily activities
  • A shorter hospital stay

 

The actual fusion of the bones is successful in most patients – especially those who have their own bone used in the grafting process. About eight or nine out of 10 patients are satisfied and experience long lasting and substantial relief from symptoms after the surgery.

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