Cervical spinal fusion

Cervical spinal fusion is surgery that joins two or more of the vertebrae in your neck. When these bones are joined together, it's called fusion. After the joints are fused, they can no longer move.

During the surgery, the doctor uses bone to make a "bridge" between your vertebrae. This bridge may be strengthened with metal plates and screws. In most cases, the doctor uses bone from another part of your body or bone that has been donated to a bone bank. But sometimes human-made bone is used.

To do the surgery, the doctor makes a cut in either the front or the back of your neck. The cut is called an incision. It leaves a scar that fades with time.

After surgery, you will have a short hospital stay. Your neck will feel stiff or sore. You will get medicine to help with pain.

Most people can go back to work after 4 to 6 weeks. But it may take a few months to get back to your usual activities.

Cervical spinal fusion joins two or more vertebrae in the neck to make the neck more stable. It may be done:

• After an injury. This can help prevent a bone fracture from causing instability or damage to the spinal cord, which may result in paralysis.
• To treat conditions such as misalignment of the vertebrae or spinal deformities.
• In combination with decompressive surgery to decrease pressure on the spinal cord and/or spinal nerves in the neck. The pressure can be caused by things like spinal stenosis, a herniated disc, or the effects of rheumatoid arthritis.
• Because of an infection or a tumor.

Cervical spinal fusion (arthrodesis) joins selected bones in the neck (cervical spine ). There are different methods of doing it.

• Bone can be taken from elsewhere in your body or obtained from a bone bank (a bone graft). The bone is used to make a bridge between vertebrae that are next to each other (adjacent). This bone graft stimulates the growth of new bone. Human-made (artificial) fusion materials may also be used.
• Metal implants can be used to hold the vertebrae together until new bone grows between them.
• Metal plates can be screwed into the bone, joining adjacent vertebrae.
• An entire vertebra can be removed, and the spine then fused.
• A spinal disc can be removed and the adjacent vertebrae fused.

This procedure can be done through an incision on the front (anterior) or back (posterior) of the neck.

Often spinal fusion is needed to keep the spine stable after injury, infection, or a tumor.

The research on how well surgery helps people is not clear. When symptoms such as numbness or weakness in the arm suggest that a neck problem is causing a pinched nerve (radiculopathy), surgery may help you feel better faster. Small studies show that people may have improved symptoms, like better hand function, a few months after surgery compared with those who did nonsurgical treatments, like physical therapy. But surgery may not be any better than nonsurgical treatment in the long run.

If you have neck pain alone, with no signs of a pinched nerve, spinal fusion surgery will probably not help.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation. Walking may also decrease your muscle soreness after surgery.
• Follow your doctor's directions about not lifting anything that would strain your neck and back. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
• Avoid strenuous activities, such as bicycle riding, jogging, weightlifting, or aerobic exercise, until your doctor says it is okay.
• Do not drive for 2 to 4 weeks after your surgery or until your doctor says it is okay.
• Avoid taking long car trips for 2 to 4 weeks after surgery. Your neck may become tired and painful from sitting too long in one position.
• You will probably need to take 4 to 6 weeks off from work. It depends on the type of work you do and how you feel.
• You may have sex as soon as you feel able, but avoid positions that put stress on your neck or cause pain.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain pill is making you sick to your stomach:
  • Take your pills after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain pill.

Incision care

• You will be given specific instructions about how to care for the cut (incision) the doctor made. The instructions will depend on the type of materials used to close the cut.

Exercise

• Do exercises as instructed by your doctor or physical therapist to improve your strength and flexibility.

Other instructions

• Follow your doctor's instructions about wearing a brace or collar to support your neck.
• To reduce stiffness and help sore muscles, use a warm water bottle, a heating pad set on low, or a warm cloth on your neck. Do not put heat right over the incision. Do not go to sleep with a heating pad on your skin.