Cervical Spine Fusion

 

Cervical Spine Fusion is a commonly-performed procedure for treating disc herniations, spinal stenosis, arthritis and other problems in the cervical spine that cause pain and dysfunction, which do not respond to conservative treatment.

radiographic image of the cervical spine with fusion instrumentation

Anatomy

The cervical spine consists of the seven bone segments or vertebra which extend from the skull to the thoracic spine.  These comprise the architectural structure of the neck, which holds the head, weighing about ten pounds.  The neck has the most range of motion of any part of the spine due to two specialized vertebrae at the base of the skull.  Between the vertebrae of the neck are the intervertebral discs, which provide shock absorption and act as ball bearings, upon which the bones of the neck move.

Issues in the cervical spine can be caused by a number of conditions.  Some of the most common are arthritis, a bulging or herniated spinal disc, spinal stenosis (narrowing of the spinal canal), tumors, infections or bone spurs.  A person can also have problems after an injury to the cervical spine, as in a fall, diving or motor vehicle accident. Sometimes a person can be born with a misalignment of the neck bones which may also cause problems.

Whenever the spinal cord or nerves are compressed in the neck, pain, numbness, tingling or weakness can occur in the shoulders, arms or fingers or a combination of these.  The symptoms may be felt on one side of the body only, but occasionally can occur on both sides of the body.  It is important that this condition be diagnosed and treated quickly to prevent the symptoms from becoming permanent.

Cervical fusion surgery involves removing the injured or degenerative spinal disc between the vertebrae, inserting cadaver bone or your own bone in the place where the disc was and stabilizing the neck bones with plates, screws and/or rods. The fused level is unable to move; however the level(s) above and below will move as before.  In time, the inserted bone will grow or fuse into your own bone.

When Surgery is the Best Treatment Option

When conservative treatment doesn’t provide symptom relief and return of function, surgical intervention is considered.  Today, cervical fusion surgeries are usually performed on an outpatient basis at Mary Immaculate Hospital by OSC Spine Surgeons Drs. Jeffrey R. Carlson and Mark W. McFarland.

After a date has been scheduled for your cervical spine fusion, you will be given detailed information about your surgery and instructions regarding your recovery by the OSC Surgical Scheduler who works for your OSC surgeon.  You may be fitted for a cervical collar to wear during the first part of your recovery.  If you are given a collar, it is important to bring it with you to the hospital on the day of your surgery. Your surgeon will decide what is appropriate for you.

You may also be given a bone growth stimulator to wear during recovery to help your bones fuse more quickly.  This is a collar-like device which is worn for several hours a day that stimulates bone growth by delivering a gentle electric current to the surgical site.  Not all patients will need a bone growth stimulator, however, some patients may be at a higher risk for non-union of their spinal bones.  These are patients who: 1) smoke; 2) have multi-level fusion surgery; 3) have severe spondylolisthesis (bone slippage); 4) have a previous spine fusion that failed; 5) have other medical conditions that can make them predisposed to non-fusion.  Your physician will discuss with you your medical history and upcoming surgery and decide if you would benefit from the use of a bone growth stimulator.

The Surgical Scheduler will let Mary Immaculate Hospital know that you need pre-operative testing, which will be arranged for you less than thirty days before your surgery.  You will report to the hospital for this testing, which may include an EKG, blood work, blood pressure monitoring, etc.  We want to ensure that you are well enough to undergo anesthesia and surgery and then recover without having other medical issues prevent you from doing so.  This testing can also alert your surgeon to an issue that should be remedied before you have surgery.

While you are at the hospital for pre-surgical testing, you will also be given sponges and a special antiseptic soap to use in the shower for three days prior to your surgery.  It is important that you comply with this pre-operative, germ-reduction protocol.

If you have other medical conditions, such as a cardiac issue, diabetes, etc., for which you receive regular medical care, you will be asked to get medical releases from the specialists who provide your care, before you can have surgery.  If you have dental issues, you should see a dentist before your surgery to make sure that your teeth and gums are healthy and free from infection.

The physicians at OSC will review your imaging studies to determine the best approach for your surgery, either from the front (anterior) or the back (posterior).  Most often, for one, two or three level disc fusion, the anterior approach will be used.  An incision can be made to the front of the neck, off center, which allows the surgeon to move the esophagus and other soft tissues to access the spinal column.

If there are more than three levels to be fused, the posterior approach may be used.  The reason for this is that the amount of hardware necessary to surgically stabilize your spine (plates, rods and screws) can be too irritating to the esophagus, so it may better that they be affixed to the back of the spine.

Preparing for Surgery

In the weeks prior to your surgery, you should focus on wellness.  If you smoke, quit. Smoking has been found to be very detrimental to the healing process, especially after surgery.  Eat healthful, nutritious foods.  If you need to lose weight, even a small loss before surgery can make a difference.  Exercise, stretch or take a walk – participate in some physical activity every day to help condition your body.

Prepare your home to welcome you after you have surgery.  Make sure your sheets are clean, the laundry is done and that the house is cleared of scatter rugs or obstructions that can trip you up after surgery.  Stock the fridge and freezer with nutritious food that can easily be thawed or warmed up and which doesn’t require a lot of effort to cook.  Get a friend to walk and feed your dog (or cat) for the first few days while you recover.

In the last few days before your surgery, you will be called by your OSC Surgical Scheduler and given a time to report to the hospital on the day of your surgery.

The night before your surgery, it is imperative that you not eat or drink anything after midnight.  If advised to do so, you may take heart, high blood pressure or GERD (gastric reflux disease) medication with a very small sip of water in the morning before surgery.  Do not take any of your regularly prescribed medications unless you are advised to do so to by your surgical scheduler.

At the Hospital

Please arrive at your scheduled arrival time and check in.  You will be given hospital ID bracelets to wear. Your companion will be asked to wait in the waiting area and you will be taken to a pre-surgical preparation room.  You will be given antiseptic body wipes and told to use them before changing into your surgical gown.  You will also be given antibacterial nose swabs and be asked to swab the inside of your nose multiple times.

After you have completed these steps, you will be visited by multiple hospital personnel who will start an IV, ask identifying questions, that may be repetitive for your safety, and check your vital signs.  You may be asked to sign some administrative paperwork regarding your surgery.  Your companion will usually be allowed to rejoin you in the pre-operative holding area before you are taken for surgery.  You will be visited by the anesthesiologist and your OSC Spine Surgeon. Finally, members of your OR team will come to wheel you to the Operating Room and your companion will go back into the waiting area during your surgery.

After surgery, you will be taken to the recovery room/post-operative area where your vitals will be monitored as you awaken from sedation and your companion will be allowed to join you.  After monitoring you and ensuring that you can safely be released, you and your companion will be given discharge instructions, prescriptions for medications and you will be sent home to recover.

At Home

Typically, patients go home and spend most of the time sleeping for the first few days after a cervical fusion surgery.  Rest is very important; however it is also important that you get up and walk around every few hours. This will help you heal more quickly and metabolize the anesthesia drugs used.  The effects of anesthesia may leave you feeling fatigued, foggy or confused.  This is normal and should resolve in a few days.

Patients who have cervical fusion may experience a sore throat from the surgical intubation (having a breathing tube inserted to assist with breathing while under sedation). Those patients who have the anterior approach surgery will have the esophagus moved during surgery, which may also cause painful swallowing for a few days.  Chloraseptic spray or throat lozenges will help ease the discomfort.  Smoothies, milk shakes or ice cream are also tolerated well until the sore throat goes away.

It is important that you stay well-hydrated, so drink plenty of water as you recover.  Eat small, nutritious meals.

Incision care is very important during this time.  You may have stitches, staples or your wound may be closed with surgical glue.  You may also have a drain coming from your incision that has been sutured into place.  It is important to keep the incision area dry and covered while you heal.  Your physician may order a home health nurse to come to your home to ensure your incision is healing properly, change dressings or to remove the drain from your incision.

Pain medication will be prescribed by your physician, if necessary, to manage post-operative pain.  You may also be given muscle relaxants and antibiotics.  It is important that you take this medication as prescribed.  Pain medication will likely cause constipation, which can be exacerbated by a lack of physical activity after surgery.  Stool softeners, laxatives or fiber supplements should be taken to prevent any issues.

You may run a low-grade fever after surgery; this is fairly common.  However a fever of higher than 101.5 degrees is cause for concern and your surgeon should be notified immediately.  Also be on the lookout for redness or excessive drainage with pus around the incision site, which indicates infection.

You will be scheduled for a follow-up visit with your OSC surgeon in ten days to two weeks after surgery.  You may have stitches or staples removed from your incision. At that time, your surgeon will review your progress and determine if you should return to work, activities, driving, etc., or if you will need more time to recuperate.  You may also be given a prescription for Physical Therapy to help you build strength and restore function.