Jeffrey R. Carlson, MD, MBA, CPE, FAAOS
All patients are understandably nervous about their spine surgery, especially if it is the first surgery they will ever experience. As a spine surgeon, I get to enter the operating room multiple times a week and see how all of the physicians, OR nurses and medical professionals work together to ensure that the patient is safe, stable and that the surgery that needs to be performed goes according to plan. Patients don’t have that “big picture” view of such an intensely personal situation for each of them, so I try to share my years of surgical experience and perhaps ease some of the common fears that patients share with me.
Disc herniations in the neck can be so severely painful that patients want to get their surgery done as soon as possible to relieve the pain. This involves removing the disc from compressing the nerve which in turn relieves the pain. After the disc is removed, the space between the bones needs to be filled so the spinal bones are stable. There are two ways to reconstruct that space; 1) with a cervical disc replacement which attempts to maintain the motion of the spine or 2) the more classic cervical (neck) fusion, using rods, plates and screws, intended to keep the bones from moving.
These treatment options are discussed with the patient along with their inherent risks and benefits. When it comes to cervical (neck) fusion, a frequent question I get asked is about any loss of motion that will occur. Fusion’s goal is to provide stability to the vertebral bones by removing the flexible cartilaginous disc and replacing it with a solid construct that allows your vertebral bones to grow together. This necessitates a loss of motion at that particular spinal segment that was fused, and the concerned patient will astutely ask what their neck motion will be like after a fusion.
The University of Freiburg, Germany published their study concerning this exact question (Spine, September 15, 2021 – Volume 46 – Issue 18). They collected objective and patient responses concerning restriction of motion from 97 patients before and after they underwent a cervical spinal fusion. First, they found that each of the patient’s pain scores significantly improved, which is the primary goal of the procedure. Next, and importantly, they found significant improvements in their patient’s ability to perform their normal activities over three months and continued to improve up to a year after the surgery. They were also able to answer the basic question of the study by asking patients about their ability to move their neck before and after surgery. The patients related that their neck motion in every direction was better than before surgery! The objective x-ray values for their patient’s range of motion showed no significant difference in flexion and extension, but an improvement in rotation.
This study explains that cervical fusion works to relieve pain and improve the function of patients with a herniated disc, which is the goal of the surgery. It further helps patients see that they will not notice any loss of motion after fusion surgery, in fact, will feel as though they have improved their motion from what they had prior to the fusion surgery. This noticeable improvement in motion may be related to the relief of the pain and our body’s natural protective muscular tension due to the surgery removing the disc herniation. You can feel confident that the surgery will work and your range of motion will actually improve after a cervical spine fusion.
To make an appointment with Dr. Jeffrey Carlson, call Orthopaedic & Spine Center at 757-596-1900, or use our online scheduling tool.