Cervical Fusion Surgery

Fusion of the Neck Vertebrae to Relieve Pain and Nerve Symptoms

doctor showing vertebrae display to female patient
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Cervical fusion is a surgical procedure that links together damaged segments of the vertebral column in the neck. This surgery is usually required when the cervical vertebrae -- and the discs between each vertebra -- have become damaged as a result of an injury or chronic wear-and-tear.

During surgery, the discs between one or more vertebrae are removed, and bone growth is stimulated to link together adjacent vertebrae.

Often, a metal device is used to stabilize the fusion until the bone growth is solid.

Cervical Fusion Surgery

Cervical fusion, also called an arthrodesis, permanently links together two (or more) adjacent vertebrae. Normally, there is a spinal disc between each two vertebrae. The disc acts as a cushion, but also allows some movement between the vertebrae. Most often a cervical fusion is performed because the spinal disc is causing problems by pushing on a nerve (called a disc herniation). This nerve pressure can cause irritation leading to symptoms of pain, tingling, and numbness in the neck and arms.

When a cervical fusion is performed, the disc or fragments of the disc are removed. The bones of the vertebrae are then permanently linked together. This linkage occurs both with bone graft (the permanent solution) and often a metal plate, screw, or rod (the temporary solution). The metal simply holds the vertebrae in position while bone permanently fuses the segments together.

Once the bone has linked the two vertebrae together, the fusion is considered solid, and resumption of normal activities is allowed.

Recovery From Cervical Fusion

Recovery from cervical fusion depends on a number of factors. As mentioned, the surgery is considered a success when the symptoms are improved, and the bone has healed across the fused vertebrae.

This fusion process usually takes two to three months. The activity allowed during that time will depend on the strength of the fusion. In some patients with solid bone and strong metal fixation, more activity may be allowed. In cases where there are concerns about a patient's ability to fuse the vertebrae, the recovery may be more cautious.

Complications From Surgery

The most common complication of cervical fusion surgery is when it fails to relieve the persistent neck pain. Fortunately, this complication is not common, but it can occur. Studies have found success rates between 80 to 90% with cervical fusion surgical treatment for radiculopathy (nerve pain).

The other potential major complication of a cervical fusion is a lack of adequate bone growth between the adjacent vertebrae. This is called an incomplete fusion, and may require additional surgery. Bone may not grow adequately for a number of reasons, and doing things like avoiding smoking and not taking medications or drugs that are known to interfere with bone growth.

Other factors (such as a person's natural bone strength) are difficult to change.

Other complications of cervical fusion can include nerve injury, difficulty swallowing, infection, and bleeding. Many patients are concerned about injury to the spinal cord. Of all of the complications listed, this is probably the least common. The risk of spinal cord injury is a small fraction of a percent.

Alternatives to Cervical Fusion

If a patient only has a small disc herniation, often just the disc fragment can be removed without requiring a fusion. But if a patient needs the full-blown surgery, there aren't too many alternatives -- yet. There are new surgical procedures in development for spinal disc problems that are designed to remove the damaged disc but still allow for movement at the affected vertebrae. These alternatives include dynamic stabilization and spinal disc replacement. More commonly performed in the lumbar spine (lower back), these procedures may help maintain motion while also solving the disc problem.

Sources:

Rhee JM, et al. "Cervical Radiculopathy" J Am Acad Orthop Surg August 2007 ; 15:486-494.

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