There are several symptoms that lead patients to get neck surgery, including: weakness, severe or chronic nerve pain, degenerative disc or facet disease, progressing deformity and instability, Surgery is most likely to be recommended if nerve compression and spinal cord compression are causing the experienced pain, especially if it is leading to myelopathy. There are several types of surgery that can be done on the cervical spine, one of which is posterior cervical fusion.
An instable spine, meaning the integrity of the spine has been compromised and it can no longer maintain its normal configuration when performing daily tasks, is a common reason patients choose to undergo spinal fusion. In spinal fusion surgery, two or more vertebrae are fused together to promote stability in the spine. Sometimes this surgery fixes a spinal deformity or stabilizes the area after fracture. When the problem exists in the cervical spine—the part of the spine that supports the neck—it is called cervical fusion. Doctors can choose to take an anterior (front) approach or a posterior (back) approach.
Before surgery, optimize your chances for a positive outcome by addressing any other modalities you may have and stopping dangerous habits such as smoking, which can affect the bones’ ability to heal.
To do the surgery, the patient has to lie face down so the surgeon can reach the affected vertebrae from the back of the neck. This differs from the anterior approach, which requires the surgeon to go in through the front of the neck. In the posterior approach the bone graft is placed on the lamina through a small window the surgeon has created through the back of the neck instead of wedged in through the front. Because the graft cannot be wedged it, doctors rely on it to fuse itself, often with the help of spinal hardware to hold the graft in place while this happens. Sometimes a posterior approach is used after an anterior approach has failed; utilizing metal rods or plates at the back of the spine to provide more support and allow the bone graft to fuse the vertebrae successfully.
The bone graft used may come from a cadaver bone, or it could be pulled from the patient’s own locally harvested bone. If the bone graft cannot be formed from the area of the spine undergoing operation, additional bone will be pulled from the hip. This requires additional incisions and steps to the surgery.
After surgery, most patients recover in the hospital for a few days. During this time, pain medication is used to manage post-operative pain but patients will be encouraged to get up and move to limit complications associated with low mobility after surgery. A catheter, however, may be needed for one or two days. After you are released, you will be asked to come back in to have your wound checked and to have sutures removed.
The main purpose of this surgery is to fuse the cervical spine, correcting potential deformity, improving stability, decreasing or eliminating pain and/or stabilizing a fracture.
Immediate relief from pain is the best benefit of posterior cervical fusion surgery. Because the surgery is less invasive than other approaches, recovery is faster. Relief of chronic pain makes it easier to perform daily activities. The surgery also often relieves numbness, tingling and weakness in the neck and extremities. In cases when pain radiates to other parts of the body that can also be relieved as pressure on the spinal cord and its nerves is relieved.
There are a lot of complications related to spine surgery, including posterior cervical fusion. Most complications, however, are rare. These complications include: bleeding that can lead to a blood transfusion, blood clots, infection, lung problems, spinal cord and nerve injury, problems with the implant or instruments used to stabilize the spine, nonunion that occurs if a fusion does not heal as planned and dural tear. There are also risks associated with general anesthetic including, but not limited to, death, stroke, blood clots in the deep veins, pulmonary embolism and drug allergy.
When several vertebrae are fused together, a decrease in mobility may be experienced because motion is eliminated in that part of the spine. This can also lead to faster degeneration of surrounding disks and require subsequent surgeries.
Posterior cervical fusion is done to treat conditions that affect the spinal cord and spinal nerves in the cervical spine. This can result in relief of many symptoms including: weakness in hands and arms, radiating or shooting pain, numbness, a radiating tingling sensation, localized pain, inability to turn or move without pain and trouble with extremity control. The best symptom posterior cervical fusion surgery can solve is poor quality of life caused by these symptoms.
Before opting for spinal surgery, doctors will typically recommend several other interventions including pain medication, physical therapy and massage therapy. Many individuals will try steroid injections to treat pain in the cervical spine, as well. When these approaches fail, surgery is often recommended. Other surgical options include anterior cervical discectomy and fusion (ACDF), cervical total disc replacement and cervical laminectomy. Discuss all surgical options with your physician.
A fair price for cervical spinal fusion surgery is about $28,000 but procedures often run anywhere from $19,000-$80,000 dollars. For any spinal surgery it is not uncommon for total costs to reach $100,000 after calculating in the procedure, diagnosis imaging and recovery expenses such as a neck brace and physical therapy.
“Treatments.” Posterior Cervical Spine Fusion Surgery | VSI. Accessed May 03, 2018. https://www.spinemd.com/treatments/posterior-cervical-fusion#Posterior Cervical Fusion.
B, Theresa, Anne V., and Celestine W. “When to Have Neck Surgery | Neck Pain | Spine Surgeon.” Donald Corenman MD DC | Spine Surgeon Colorado | Vail, Denver, Aspen. December 21, 2016. Accessed May 03, 2018. https://neckandback.com/treatments/when-to-have-neck-surgery/.
Institute, Laser Spine. “Posterior Cervical Fusion | Minimally Invasive Stabilization (MIS) Options for Lumbar Spine.” Laser Spine Institute. Accessed May 03, 2018. https://www.laserspineinstitute.com/spinal_orthopedic_procedures/posterior_cervical_fusion/.
“Healthcare Bluebook.” Healthcare Bluebook Home. Accessed May 03, 2018. https://www.healthcarebluebook.com/page_ProcedureDetails.aspx?cftId=23&directsearch=true.
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