POSTERIOR CERVICAL FUSION

Common Causes of Neck Problems and Their Treatments

Neck problems can arise from a variety of causes, often requiring different approaches for treatment. Understanding these underlying issues is crucial for effective management.

Many neck problems are due to degenerative changes in the intervertebral discs of the cervical spine and the joints between each vertebra. These changes can lead to conditions that cause significant discomfort and functional limitations.

Other issues may stem from injury to parts of the spine or complications from earlier surgeries, adding layers of complexity to diagnosis and treatment.

Potential Complications of Posterior Cervical Fusion Surgery

When considering posterior cervical fusion surgery, it’s crucial to understand the potential complications that might arise. Like any surgical procedure, there are inherent risks, particularly because this surgery targets the spine and spinal cord, which are vital areas of the body.

Serious Complications

• Nerve Damage: Surgery near the spinal cord can result in nerve injury, leading to possible numbness, weakness, or loss of function in limbs.
• Infection: As with any operation, there’s always a risk of developing an infection at the surgical site.
• Bleeding and Blood Clots: Excessive bleeding during or after the procedure is possible, as well as the formation of blood clots, which can pose significant health threats.

Long-term Considerations

• Pain and Impairment: Post-surgical pain might persist and, in some cases, a permanent impairment that affects mobility or daily activities could occur.
• Hardware Issues: The hardware used in fusion can sometimes fail, necessitating further surgery.
• Nonunion: There’s a chance that the bones do not fuse as expected, leading to additional procedures.

Before proceeding with surgery, a thorough discussion with your doctor is essential. Such conversations will provide a clearer understanding of these risks based on your unique health condition, helping ensure you make a well-informed decision.

Remember, this is a general overview, and only your healthcare provider can give you personalized advice and a detailed risk assessment.

Posterior Cervical Fusion is Used to Treat a Variety of Conditions:

• Cervical spondylosis: This condition causes the discs in the neck to degenerate and bulge, putting pressure on the nerves. This can result in pain, numbness, and weakness in the arms and hands.
• Cervical instability: Occurring when the vertebrae in the neck are not properly aligned, this can result from trauma, arthritis, or tumors. Symptoms include pain, numbness, and weakness in the arms and hands, as well as difficulty walking and balance problems.
• Cervical stenosis: This is a narrowing of the spinal canal in the neck, which can put pressure on the spinal cord and nerves, leading to pain, numbness, and weakness in the arms and hands.
• Cervical tumors: Rare tumors in the neck can grow large enough to press on the nerves, causing pain, numbness, and weakness in the arms and hands.

By addressing both the root causes and specific conditions, medical professionals can tailor treatments such as posterior cervical fusion to effectively alleviate symptoms and improve quality of life.

Rationale for Posterior Cervical Fusion

The decision to perform a posterior cervical fusion is not taken lightly, as surgery is not necessary for every neck pain issue. This procedure is specifically designed to address a range of cervical spine conditions:

• Motion Limitation: By fusing the vertebrae, the procedure stops excessive motion between segments, which is particularly beneficial for patients experiencing mechanical neck pain due to segmental instability.
• Spinal Stability: In cases where the spine is unstable from a fracture or dislocation, the fusion stabilizes the structure, preventing further injury. This is crucial when the spinal cord is at risk, as stabilization can prevent potential damage during the healing phase.
• Facilitating Rehabilitation: When severe spinal cord damage occurs, leading to conditions such as paralysis, the procedure can aid in quicker rehabilitation. By stabilizing the spine, patients can transition out of bed and into a wheelchair sooner, allowing early rehabilitation efforts.
• Correction of Deformities: The procedure may also be recommended for controlling deformities like cervical kyphosis. This condition is characterized by an abnormal forward curve of the spine, and a fusion can help restore a more natural posture.

By understanding the specific goals and applications of a posterior cervical fusion, patients can appreciate why this surgical option may occur for certain spinal conditions.”

The Benefits of Posterior Cervical Fusion

• Pain relief: Posterior cervical fusion can help to relieve pain caused by conditions such as cervical spondylosis, cervical instability, and cervical stenosis.
• Improved range of motion: Posterior cervical fusion can help to improve the range of motion in the neck.
• Increased stability: Posterior cervical fusion can help to increase the stability of the neck. This can help to prevent further injury to the neck and reduce the risk of pain and other symptoms.

Goals of Spinal Fusion

The goal of spinal fusion is to stop the motion caused by segmental instability. Consequently, this reduces the mechanical neck pain caused by too much motion in the spinal segment.

You may also hear the term anterior cervical fusion. Surgeons use this procedure to commonly treat neck problems. The surgeon works from the front (anterior) of the neck. Doctors place a bone graft between two vertebral bodies (interbody area) to replace the disc that normally sits between them. During the healing process, the vertebrae grow together, creating a solid piece of bone.

Differences Between Anterior and Posterior Fusion

While anterior cervical fusion focuses on addressing problems from the front of the neck, posterior fusion is another approach with its own unique applications. In posterior fusion, the bone graft is strategically placed on the backside of the vertebrae. This method is often used to address fractures and dislocations in the cervical spine. Additionally, it plays a crucial role in correcting deformities such as cervical kyphosis.

Key Considerations

• Anterior Interbody Fusion: Commonly used for general neck issues, with the procedure initiated from the front of the neck.
• Posterior Fusion: Employed for specific spinal conditions, with the bone graft positioned at the back, addressing structural concerns and deformities.

Both techniques aim to promote the fusion of vertebrae, ensuring stability and relieving pain. Understanding the distinctions between these approaches can help patients and medical professionals make informed decisions tailored to individual needs.

• Related Document: Anterior Cervical Fusion
• Related Document: Bone Grafts

Instrumented Posterior Cervical Fusion

When a bone graft becomes held tightly in place, it will fuse the vertebrae together. To improve fusion, doctors commonly use metal plates, screws, and rods.  Also, surgeons use many different types of metal implants to maximize the healing of the fusion. Bone heals best when held still—without motion between the pieces trying to heal. Similarly, the healing of a fusion appears the same as the healing of a fractured bone, such as a broken arm.
Stabilizing the spine after a fusion is crucial, as it ensures that the vertebrae can grow together into one solid bone. This stability is particularly important when addressing mechanical neck pain, as it prevents excess motion between the vertebrae caused by segmental instability, which can significantly reduce discomfort.When the spine is unstable due to a fracture or dislocation, surgical stabilization becomes vital. It protects the spinal cord from potential injury during the healing process. Even in severe cases where spinal cord damage has resulted in paralysis, a spinal fusion may be recommended. This stabilization allows patients to transition more quickly from bed to a wheelchair, promoting early rehabilitation and aiding the recovery process.

By understanding the parallels between bone healing and spinal fusion, we can appreciate the necessity of maintaining stability for effective recovery and long-term spinal health. However, the neck does not hold still very well, even with a brace worn around the outside of the neck. 

To improve the success of a posterior fusion, metal rods or plates are attached to the bone structures in the back of the spine. Additionally, surgeons may also use stainless steel or titanium cables. When surgeons use screws and cables, patients may wear a brace for a short period of time, or not at all.

Key Rehabilitation Considerations:

Physical Therapy and Exercises:

• Physical therapy plays a crucial role in the recovery process, helping patients regain strength, range of motion, and functionality. Therapists often design personalized exercise programs tailored to the patient’s condition.

Use of Assistive Devices:

• The use of neck braces or other assistive devices may be recommended to protect the surgical area and support healing. These devices should be used as directed by healthcare professionals.

Posture and Movement:

• Patients should keep good posture and avoid movements that strain the neck. Proper ergonomic setups, whether at home or work, can aid in maintaining correct posture.

Patient Education:

• Understanding the condition and rehabilitation process empowers patients to actively engage in their recovery. Education on what to expect and warning signs for complications is essential.

The duration of recovery can range from several weeks to months, and regular follow-up visits with the surgeon are essential to monitor progress and address any concerns or complications that may arise. Long-term strategies, such as ongoing exercises and lifestyle adjustments, are often necessary to maintain neck strength and flexibility post-recovery.

The Surgeons at the Southwest Scoliosis and Spine Institute

We invite you to make an appointment to speak with us about your neck and the pain you are having.  To date, we have seen more than 100,000 patients and performed over 16,000 surgeries. At Southwest Scoliosis and Spine Institute, we are committed to providing the highest quality care in the diagnosis and treatment of complex spine, scoliosis, and revision surgery—including pediatric and adult scoliosis, spinal deformity, spinal tumors, and degenerative conditions of the spine. Our practice and exam rooms offer a private, comfortable setting where our physicians can spend as much time as necessary to find the right treatment plan customized for you to eliminate the pain and embarrassment of your neck condition.

If you have questions or would like to contact us through email, please fill out the form and we will get back to you shortly.

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National Library of Medicine: Posterior Cervical Fusion