Most neck pain is caused by wear and tear that occurs in the intervertebral discs and joints of the cervical spine, or neck. Many patients who have neck pain do not require surgery. However, if non-operative treatments like epidural steroid injection or physical therapy fail to control your pain, your surgeon may suggest a cervical laminectomy and/or discectomy with or without fusion.
Cervical laminectomy and/or discectomy with possible fusion can help to remove pressure from the nerves caused by bones spurs or bulging or herniated discs as well as stop the motion between two vertebrae if fused. The type of surgical procedure recommended by your surgeon will be determined by the nature and extent of your symptoms as well as the findings on your imaging studies.
Types of Cervical Fusion
- anterior fusion - performed through the front of your neck
- posterior fusion - performed through the back of your neck
The type of fusion approach you will have is dependent on your symptoms and specific diagnosis. Talk with your doctor about the exact approach of your cervical fusion surgery.
Fusion with Instrumentation
Depending on the individual patient, a spine surgeon can choose to also have metal rods, screws or hooks used in combination with the bone graft to further stabilize the cervical spine.
- autograft - small piece of bone taken from your own body, usually your pelvis or hip
- allograft - small piece of bone taken from a bone bank
About Your Surgery
For most cervical spine surgeries, patients are given general anesthesia to put them to sleep. A breathing tube may also be inserted to assist your lungs throughout the procedure.
Patients are placed on a special operating room bed that allows for optimal access to the neck, room for the surgeon to work and helps greatly reduce the potential for blood loss.
Your doctor will make a short incision in your neck to expose the correct area of the spine. An X-ray is used in the operating room to ensure that the correct bone/disc(s) is operated upon. Some surgeons may also use a special surgical microscope during surgery to magnify the area on which he or she is operating.
Your surgeon may use small cutting instruments to carefully remove soft tissue near the spinal nerves. Before fusion takes place, the surgeon removes all or part of the lamina bone, takes out any disc fragments and eliminates any nearby bone spurs. This is known as a laminectomy. Next, your surgeon will remove the affected disc, which is the cushion between your vertebrae, as well as any arthritic areas. A bone graft is then placed between the vertebrae where the disc was originally. Eventually, this graft will fuse to the surrounding vertebrae to prevent abnormal motion of the area of the neck.
At this time, your spine surgeon may choose to fix the bones in place with a single choice or combination of metal screws, rods and plates. A fusion with instrumentation, or hardware, can hold the vertebrae in place while the bone graft fuses properly. The less motion there is between the healing bones, the higher the chance of successful fusion.
An anterior fusion may also be done in a way that spreads the vertebrae apart trying to restore the height between them.
Once this is complete, the muscles and soft tissue is put back into place and the skin is closed with sutures, staples, skin glue or Steri-Strips, which are small pieces of tape.
Length of Stay
Your length of stay in the hospital will depend on the reason that you needed to have cervical spine surgery. Most patients go home the day after surgery, but your surgeon will decide when you are ready for discharge.
If you need rehabilitation before going home, a doctor from the Physical Medicine and Rehabilitation department will see you and make specific recommendations regarding your discharge.
You need to be able to walk, eat, urinate and your surgical wound must be healing well.
Cervical Fusion Recovery at Home
- Continue to gradually increase your activity, and walking within and outside the home is encouraged.
- Avoid lifting and strenuous activity.
- Do not lift objects greater than 5 pounds
- until advised by your doctor.
- Avoid lifting above the waist level and above your head for any prolonged period of time.
- Do not drive a car. Your doctor will give you specific instructions about driving on discharge or when you follow-up in the office. You can ride as a passenger in a car as directed.
- Climbing stairs at home is permitted and tolerated with caution.
- You may need to wear a neck brace; your spine surgeon will instruct you as needed.
- Sexual activity may resume when indicated by your doctor.
- Remember to call and schedule your follow-up appointment with your doctor once you are at home.
- You may shower, but avoid bathtubs and whirlpools and swimming pools until cleared with your doctor.
- If you have Steri-Strips cover your incision as directed by your doctor. You or a companion may remove the tapes as directed. If your tapes do get wet, you may pat tapes dry or use hair dryer on cool setting.
- If you have staples, you may shower but do not scrub over incision.
- Do not apply lotions or creams near incision site.
Contact your doctor immediately if you have:
- swelling on or around the incision
- incision becomes red and hot or has drainage
- difficulty swallowing
- difficulty breathing or chest pain
- swelling or tenderness in your arms
- fever of 100° or higher