Most neck pain is caused by wear and tear that progresses as we age, leading to worsening arthritis-type pain. This occurs in the intervertebral discs and joints of the cervical spine, or neck. The majority of patients who have neck pain do not require
surgery. At times, cervical degenerative disease causes compression of spinal cord or spinal roots. If non-operative treatments like epidural steroid injections or physical therapy fail to control your pain, your surgeon may suggest a cervical decompressive
procedure with or without fusion.
Cervical decompression by laminectomy or discectomy with disc replacement or fusion can help to remove the pressure from the nerves caused by bone spurs or bulging or herniated discs, as well as stop the abnormal
and painful motion between two vertebrae, if fused. The type of surgical procedure recommended by your surgeon will be determined by the nature and extent of your symptoms, as well as the findings on your imaging studies.
Types of Cervical Fusion
- Anterior fusion is performed through the front of your neck. It involves the replacement of the intervertebral disc with a spacer secured with small screws, with or without a plate, to ensure proper alignment.
- Posterior fusion is performed through the back of your neck. It involves the use of small screws and rods to stabilize the spine and ensure proper alignment.
The type of fusion approach you will have is dependent on your symptoms and specific diagnosis. Talk with your doctor about the specific approach that will best treat your problem.
Bone Grafts
- autograft - small piece of bone taken from your own body, usually your pelvis or hip
- allograft - small piece of bone taken from a bone bank
About Your Surgery
For most cervical spine surgeries, patients are given general anesthesia to put them to sleep. A breathing tube is inserted and used throughout the procedure.
Patients are placed on a special operating room bed that allows for optimal access to the neck and allows for obtaining X-Ray images of the neck to make sure that your operation is done safely.
Your doctor will make a small incision in your neck to expose the correct area of the spine. An X-ray is used in the operating room to ensure that the correct bone/disc(s) is operated upon. Some surgeons may also use a special surgical microscope during surgery to magnify the area on which he or she is operating.
Your surgeon may use small cutting instruments to carefully remove soft tissue near the spinal nerves. Before fusion takes place, the surgeon removes all or part of the lamina bone, takes out any disc fragments and eliminates any nearby bone spurs. This is known as a posterior laminectomy. Alternatively, if undergoing an anterior surgery, your surgeon will remove the affected disc, which is between your vertebrae, as well as any arthritic areas. A bone graft is then placed between the vertebrae where the disc was originally. Eventually, this graft will fuse to the surrounding vertebrae to prevent abnormal painful motion of this area of the neck.
At this time, your spine surgeon may choose to fix the bones in place with a standalone intervertebral device or a combination of metal screws, rods and plates. A fusion with instrumentation, or hardware, can hold the vertebrae in place allowing the bones to properly fuse. The less motion there is between the healing bones, the higher the chance of successful fusion.
Once this is complete, the muscles and soft tissues are put back into place, and the skin is closed with sutures, staples, skin glue or small surgical bandage strips.
Length of Stay
Your length of stay in the hospital will depend on the reason that you needed to have cervical spine surgery. Most patients go home the day after surgery, but your surgeon will decide when you are ready for discharge.
If you need rehabilitation before going home, a doctor from the Physical Medicine and Rehabilitation
Department will see you and make specific recommendations regarding your discharge.
You need to be able to walk, eat, urinate and your surgical wound must be healing well.
Cervical Fusion Recovery at Home
- Continue to gradually increase your activity. Walking in and outside of the home is encouraged.
- Avoid lifting and strenuous activity.
- Do not lift objects greater than 5 pounds until advised by your doctor.
- Avoid lifting above the waist level and above your head for any prolonged period.
- Do not drive a car. Your doctor will give you specific instructions about driving on discharge or when you follow-up in the office. You can ride as a passenger in a car as directed.
- Climbing stairs at home is permitted and tolerated with caution.
- You may need to wear a neck brace; your spine surgeon will instruct you as needed.
- Sexual activity may resume when indicated by your doctor.
- Remember to call and schedule your follow-up appointment with your doctor once you are at home.
Wound Care
- You may shower as directed by your surgeon but should avoid submerging in bathtubs or swimming pools until cleared with your doctor.
- If you have surgical bandage strips over your incision, these will usually fall off on their own. Your surgeon may direct you or a companion to remove the tape if it does not fall off after a certain period.
- If you have staples, you may shower, but do not scrub over incision.
- Do not apply lotions or creams near incision site.
Contact your doctor immediately if you have:
- swelling on or around the incision
- incision becomes red and hot or has drainage
- difficulty swallowing
- difficulty breathing or chest pain
- swelling or tenderness in your arms
- fever of 100° or higher