Anterior Cervical Fusion
A surgeon implements an anterior cervical fusion by making an incision in the neck to accomplish the following:
- To remove pressure from nerve roots or the spinal cord caused by bone spurs or a herniated disc
- To stop the motion between two or more vertebrae
Removing pressure from the nerve roots or spinal cord can ease arm pain. Problems from pressure on the nerves, such as numbness or weakness in the arm or difficulty walking, may also improve. The fusion of the problem vertebrae reduces mechanical pain caused by too much motion in the spinal segment
Anterior cervical discectomy is one of the most common surgical procedures for problems in the cervical spine. The term discectomy means to “remove the disc.” This procedure relieves pressure on a spinal nerve or the spinal cord caused by a herniated disc.
A discectomy occurs when the surgeon intends to fuse two or more bones of the neck together. This procedure of disc removal and fusion (described below) treats degenerative problems (called spondylosis) in the neck.
In the cervical spine, surgeons usually remove the disc from the front by an incision in the front of the neck beside the trachea (windpipe). With the muscles, arteries, and nerves protected, the surgeon uses an X-ray to identify the correct disc. Removal of the problem disc then occurs. If any bone spurs are found sticking off the back of the vertebrae and your surgeon thinks they may also cause you pain, they may be removed. We take great care to not damage the spinal cord and nerve roots.
Anterior Cervical Fusion
After removal of the disc between the vertebrae, the surgeon performs a cervical fusion. The area where the disc was removed is filled with a block of bone taken from the top rim of the pelvis. Autograft refers to the term for bone taken from one’s own body. However, the surgeon may obtain bone from a source other than your body, called an allograft. Placing a bone graft between two or more vertebrae causes the vertebrae to fuse.
The anterior cervical fusion may also spread the vertebrae apart a bit, trying to restore the space between them. This recreates the normal height of the disc space and to restore the normal inward curve of the neck (called lordosis). Increasing the distance between the vertebrae also widens the opening (foramina) where the nerves come out of the spine. Restoring the size of the foramina relieves pressure and irritation from bone spurs where the nerves pass through the foramina.
Most neck problems come from a degenerative, or aging, condition of the spine.
Degenerative disc disease and cervical spinal stenosis can lead to pressure on the spinal cord or nerve roots. Surgery from the front or the back will remove this pressure on the neck. Doctors use the anterior approach more often because the pressure usually occurs on the front portion of the nerves or spinal cord.
Anterior Interbody Fusion
When an interbody fusion takes place, removal of the disc between two vertebrae occurs and a bone graft takes its place. As the body heals, the graft fuses to the vertebrae above and below it. When more than one disc needs removal, surgeons use and insert larger bone grafts. Patients usually wear a brace after the surgery. The brace limits movement between the vertebrae, increasing the chances for a successful fusion.
Bone heals best without motion between the pieces trying to heal. The healing of a fusion acts in the same manner as a fractured bone or broken arm. However, the neck does not hold still, even with a brace worn around the outside of the neck. However, the less movement the better, and a brace definitely reduces movement and proper healing.
Improvement in the success of fusion can occur by screwing metal (titanium) plates or rods to the front of the spine. This holds the vertebrae and graft rigidly in place while the fusion heals. These implants are referred to as instrumentation or internal fixation. Several different types of spinal implants may stabilize the neck and maximize the healing of the fusion. When doctors use this type of instrumentation, braces are used for shorter periods or not at all.
Post surgery X-ray of an anterior
cervical fusion patient.
If you or a loved one suffers from spinal pain, you owe it to yourself to call Southwest Scoliosis Institute at 214-556-0555 to make an appointment.