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Posterior Cervical Fusion

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Spinal fusion is a technique used to stabilize the spinal bones or vertebrae. The goal of lumbar fusion is to create a solid bridge of bone between two or more vertebrae. Spinal fusion may be recommended when the natural disc space has decreased or the spine is unstable.



Anatomy

The spine is composed of individual bones called vertebrae. There are typically five lumbar vertebrae. They are stacked one on top of another and are separated by discs, which act as an elastic cushions or shock absorbers. Discs have a soft center, the nucleus, surrounded by a tough outer ring, the annulus. Discs allow motion between the vertebrae. The interbody space is the disc space that is located between the vertebral body bones. Each vertebral segment creates a bony circle, called the spinal canal that protects the spinal cord and spinal nerves.  The spinal cord, which is the nerve center of the body, connects the brain to the rest of the body. The spinal cord and nerves travel from the cervical spine down to the lowest point of your spine, the sacrum. Spinal nerves exit the spinal canal between the vertebrae at each level. Two nerves exit each level, one on the left and one on the right. These nerves exit through openings called foramen. The discs, bony structures, ligaments and strong muscles all work together to stabilize the spine.

Posterior Cervical Fusion

A posterior cervical fusion may be recommended to stop motion between two or more vertebrae, to straighten the cervical spine from a spinal deformity, or to stabilize the cervical spine after a fracture.

This procedure is done under general anesthesia, meaning the patient goes to sleep. During the surgery the patient lies face down on a special surgical bed. The procedure is performed through a small incision on the back of the neck. The surgeon safely creates a window to see the spine. Unlike in an anterior cervical fusion, there is no place to wedge bone graft so the bone graft is simply laid on top of the lamina. The goal of surgery is for the lamina to eventually fuse. To improve fusion, spinal hardware or wires may be used to hold the graft tightly in place while the fusion heals. When spinal hardware, or instrumentation, is used to improve the success of a posterior fusion, metal rods or plates are attached to the back of the spine. If the bones do not fuse as planned this is called a nonunion, or pseudarthrosis.

Any spine surgery has surgical risks involved. You need to discuss these with your surgeon at your pre-operative appointment. Read about Preparing for Spine Surgery and General Complications from Spine Surgery.

Bone Grafting

There are multiple options for bone graft material for spinal fusion. Surgeons at the Virginia Spine Institute may use your own locally harvested bone, called autograft bone. This may come from a combination of bone from the area of the spine being operated on or from your hip bone. Bone grafting can also come from donated and prepared bone, called allograft bone. Read more about how bone grafting is used as a surgical innovation. 

Post-Operative Hospital Care

Patients usually remain in the hospital for several days after posterior cervical fusion surgery. Postoperative pain control will be achieved with the use of IV pain medication and/or oral pain medications. Patients are discharged home on oral pain medication. A catheter is typically placed in the bladder and is removed in the first one to two days after surgery. Patients begin a physical therapy walking program the day after surgery, and a physical therapist works with the patient to learn how to get out of bed and walk safely. Patients need to be comfortable with walking, climbing stairs, and getting in and out of bed before going home. The final goal is to make sure the gastrointestinal and urinary systems are working appropriately. Patients must be able to tolerate foods and urinate without difficulty prior to leaving the hospital.

Read about Recovery from Spine Surgery and make sure you understand your post-operative plan before your surgery date.

Summary

Posterior Cervical Fusion is an approved and effective method for fusing the cervical spine. The goal of surgery is to decrease pain, correct spinal deformity, and improve stability. Complications may occur but are not common. The majority of patients are satisfied with their pain relief and the results of their surgery. It is important that all patients are physically and psychologically prepared. All patients should stop smoking prior to any surgery, as smoking is extremely detrimental to your spine health, potential bone healing and successful surgical outcomes. Please review additional details with your surgeon prior to your surgery.

Multi-level Posterior Cervical Fusion

 

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