When Is Cervical Spine Fusion Necessary?

The spine has three sections: lower back (lumbar), middle back (thoracic) and neck (cervical). The cervical spine consists of seven vertebrae known as C1-C7. When those vertebrae are damaged, you can feel the pain in your neck.

Usually, doctors will first try to treat neck pain with conservative therapies, such as medications, steroid injections to decrease inflammation and physical therapy to increase flexibility and strength around the injured area. If these treatments aren’t effective, cervical spinal fusion surgery may be an option.

There are different types of spine surgery. Cervical spinal fusion surgery permanently joins two or more vertebrae in the neck.

Most cervical spine fusion surgeries are performed from the front of the neck (anterior cervical discectomy and fusion; ACDF). But in some cases surgeons prefer to go in from the back of the neck. This is known as posterior cervical surgery.

“We typically perform cervical fusion surgery to remove pressure being placed on a nerve root in the spine, or to stop the motion between two affected vertebrae,” explains Gregory Mundis, Jr., MD, an orthopedic surgeon at Scripps Clinic Torrey Pines. “Eliminating movement between the vertebrae can prevent ongoing irritation to nearby nerves, ligaments and muscles, which in turn can help reduce neck pain.”

A physician may recommend cervical spinal fusion surgery to treat neck pain when nonsurgical treatments do not help or are not appropriate. Reasons for surgery may include:

• To stabilize the neck and prevent damage to the spinal cord after an accident or injury
• To correct misaligned vertebrae such as spondylolisthesis, kyphosis or scoliosis
• To treat diseases that affect the spine such as narrowing of the spinal canal (spinal stenosis), damage to the discs that cushion the vertebrae (herniated disc), arthritis, infection or tumors

In many cases, cervical spinal fusion surgery is combined with a procedure called a discectomy. A cervical discectomy removes the damaged disc from the spine to relieve pressure it may be placing on a nerve or the spinal cord.

Usually, the surgeon removes the disc from the front of the body by making a small horizontal incision on the neck, and working around the muscles in a minimally invasive fashion. This is called an anterior cervical discectomy.

During spinal fusion surgery, the surgeon fuses the affected vertebrae by filling the space between them with a bone graft. This is a piece of bone taken from elsewhere in the body or, sometimes, donated by someone else.

“Alternatively, we may use a substance called bone graft composite instead of actual bone,” says Dr. Mundis. “This is a combination of substances such as collagen and ceramic that mimic the patient’s own bone to stimulate new bone growth and achieve the best possible fusion outcome.”

Placing the bone graft between the vertebrae causes them to grow and fuse into a single piece of bone. The surgeon also may use small metal plates, screws or rods to hold the vertebrae in place as they grow together.

Expect to spend a few hours in surgery and overnight in the hospital. Your neck will most likely feel stiff and sore for several days after surgery. You may need to wear a neck brace for a few weeks as you recover. You may work with a physical therapist to regain strength and mobility in your cervical spine.

Cervical spinal fusion surgery has a high success rate. Most people can return to their usual activities four to six weeks after surgery.

If you have neck pain that has not been relieved by medication or physical therapy, talk with your doctor or make an appointment with an orthopedic physician.