When Is Cervical Spine Fusion Necessary?

Surgery for chronic neck pain is an option when less invasive treatments fail

A man in pain grabs his neck; may consider cervical spine fusion in the future.

Surgery for chronic neck pain is an option when less invasive treatments fail

Neck pain is a common problem that can get better with self-treatment. However, neck pain that persists for long periods could be the result of something more serious. It could be an underlying health condition that requires medical attention.

Doctors will first try to treat neck pain with conservative therapies. These may include medications, steroid injections to decrease inflammation and physical therapy to increase flexibility and strength around the injured area.

You may need to see a spine specialist if conservative treatments aren’t working, and if the severe neck pain continues or interferes with your daily life.

Cervical spine surgery may be recommended in certain cases to fix a problem causing recurring neck pain. Surgery is an option only with a diagnosis based on imaging and a physical exam.

Who needs cervical spine fusion surgery?   

The spine has three sections: lower back (lumbar), middle back (thoracic) and neck (cervical). The cervical spine — or neck area of the spine — provides support and mobility for the head. It consists of seven stacked bones or vertebrae, also known as C1-C7. When those vertebrae or discs are damaged, you can feel pain in your neck.

Cervical spinal fusion surgery permanently joins two or more vertebrae in the neck into a stable piece of bone. Most cervical spine fusion surgeries are performed from the front of the neck. In some cases, surgeons prefer to go in from the back of the neck.

“We typically perform cervical fusion surgery to remove pressure from being placed on a nerve root or the spinal cord in the spine, or to stop the motion between two affected vertebrae,” explains Stephen Stephan, MD, an orthopedic surgeon at Scripps Clinic Torrey Pines and Scripps Clinic Encinitas. “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 conditions, 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

What is ACDF surgery?

An anterior cervical discectomy and fusion (ACDF) is a common neck procedure that involves removing a damaged disc from the spine to relieve pressure it may be placing on a nerve or the spinal cord and alleviate neck pain.

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. A spinal fusion is done to give stability to the area where the disc was removed.

How is cervical spinal fusion done?

During spinal fusion, the surgeon fuses the affected vertebrae by filling the space between them with a spacer. The spacer is either from the patient, from a donated cadaver bone, or a piece of titanium.


“Alternatively, we may use a substance called bone graft composite instead of actual bone,” says Dr. Stephan. “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.

What is recovery like after cervical spine surgery?

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 to your doctor or make an appointment with an orthopedic physician.

Some people with serious health problems may not be suitable candidates for surgery.

Spine care at Scripps

Scripps has been recognized as having one of the top orthopedic programs in the United States. Services include cervical spine fusion and other types of spine surgery.

Related tags: