Cervical Posterior Instrumented Fusion
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.
The spine is composed of individual bones called vertebrae. There are seven cervical vertebrae, named C1-C7, designed for flexibility and movement. The first two cervical vertebrae are very specialized to allow us to turn our head from side to side. The first cervical vertebra (or C1) is called the atlas and the second cervical vertebra (C2) is called the axis. The C1 vertebra connects the skull to the cervical spine and is formed like a ring that sits on top of C2. The C2 vertebra has a bony knob that fits into the front portion of the ring of the C1 vertebra. This bony knob is called the odontoid process or dens. The cervical spine has a lordotic shape, or a backwards “C” shape.
The vertebrae 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.
A posterior instrumented fusion is performed under general anesthesia, meaning the patient goes to sleep. During the surgery the patient lies face down on a special surgical bed. Your surgeon will make a small incision on the back to approach the spine. From here, the spinal surgeon can fuse the posterior elements of the spine. This can also be part of an approach to remove a damaged disc or to relieve pressure on the nerves of the spinal canal. Fusion is accomplished with spinal instrumentation including pedicle screws, rods and using bone graft. This is done to accomplish fusion or augment a staged procedure.
Posterior instrumented fusion is often the second part of a staged surgery. In these cases, the posterior instrumentation may be required for further decompression and stabilization after an interbody fusion. This may be needed if you have osteoporosis. If bones do not have optimal strength measured by a DEXA scan, the bones may not be strong enough to hold a fusion together while new bone grows. Some patients with severe spinal stenosis may require a more extensive decompression to free up severely narrowed nerve space.
Postoperative pain control will be achieved with the use of IV pain medication, epidural 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 eat a solid meal 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.
Posterior instrumented fusion is an approved and effective method for fusing the lumbar 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.
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