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NeuroCare Brain & Spine Center™ - Spine Care
Your questions answered…
Anterior Cervical Spine Fusion Surgery
Q: What would be a reason why someone would have the metal plate taken out?
A: Generally a metal plate placed during anterior spinal fusion surgery is
left in, even though it really is no longer necessary after the patient's bone
has had time to "fuse" or grow together.
It is fairly rare to need to remove a plate because of a problem with it or with
one of the screws that hold it in place, but this does happen on occasion. A
plate is also removed if the patient needs to have another surgery and it would
be in the way of that procedure.
Q: Why is the surgery done from the front (anterior) of the neck versus the
back (posterior) of the neck?
A: Generally, for patients that have purely a "soft" disc herniation, the
pressure can sometimes be relieved by a posterior approach. For patients that
have a combination of disc herniation and perhaps also some bony spurs that
crowd the hole through which the nerve leaves the spine, surgery is often
performed from the anterior (front) approach because the spurs are easier to
remove from the front and this can be done without retracting the delicate
spinal cord.
Q: Does everyone going through this procedure have the stability plate
installed?
A: In our experience, most patients do choose to have a stabilizing plate
applied as part of anterior cervical fusion surgery. While it is not required
for non-trauma cases, (for many years the procedure was done without plates),
using a plate does increase the success of the fusion and for patients that are
not having multiple levels treated, using a plate can eliminate the need to wear
a collar for a time after surgery.
Q: What are the risks to vertebrae & discs above & below the area of the
fusion?
A: There is evidence to suggest that patients that have a fusion of the
cervical spine may be more likely to develop problems at other levels of neck.
The thought behind this is that once one level is fused and unable to move, it
increases the stress on the vertebrae and discs around it. Movements are
transmitted to other levels and this may increase the rate at which they develop
what are called degenerative changes. Some patients do go on to need surgery at more than one level of the
spine.
Q: How does the cervical fusion differ from a lumbar fusion?
A: Cervical fusion is similar to lumbar fusion in that during the procedure,
pressure is relieved from the nerves and then a graft is placed to “fuse” the
area and prevent motion at that level of the spine.
The procedure that was done during our webcast was done from the front of the
spine and while lumbar fusions can be done from the front of the spine in
certain circumstances, more often, lumbar fusions are done from the back of the
spine.
Instrumentation is used in both cervical and lumbar fusions to help hold the
area securely while the patient's body "fuses" the bones together.
Q: What is the chance of recurrence of this procedure; the chance that the
patient will have to have a re-do operation?
A: In our experience, patients that develop recurrent symptoms after an
anterior cervical fusion are more likely to do so at other levels of the
cervical spine (as opposed to the level that was treated). It is unusual to need
a "re-do" procedure at the spinal level treated by anterior cervical fusion
because the entire disc is removed during the procedure. However, as the bones
of the neck "fuse" and motion is restricted at that level, it is recognized that
the stresses are then transmitted to other levels, which can predispose them to
degenerative changes.
As for a percent of patients that have a "re-do" procedure at another level,
different studies have been done. One study reported the incidence of developing
new symptoms as just less than 3% per year in a cumulative manner up to
approximately 25% likelihood in 10 years with about 2/3 of that group of
patients needing additional cervical spine surgery.
Q: How long does it take to heal and be without pain after an anterior
cervical fusion?
A: The recovery time after and anterior cervical fusion depends on the
number of levels treated and what activities someone wants to do.
For an average 1 level fusion (fusing two bones together), many patients go home the day of surgery. They are
able to take care of themselves and to do light activities right away; even
returning to work is OK if their job is a sedentary one. Patients that do heavy
work are generally advised to wait longer, between 4-8 weeks before returning to
their jobs.
It’s important to remember that each patient’s progress is unique to them and
follow-up visits with the surgeon who performed the procedure are the key to
monitoring progress and increasing activity in a manner that doesn’t complicate
the healing process.
Q: Why do you use cadaver bone instead of bone from the patient's hip?
A: Using a patient's own bone (taken from the patient's hip) causes much
more discomfort for the patient. Patients that had their hip bone used often
reported several weeks of pain near that incision and that's what really drove
the use of cadaver bone products. More recently, synthetic spacers have been
developed also.
The decision as to which material to use is made between the surgeon and the
patient based on the patient’s condition (e.g., how many levels are to be
treated) and other factors such as the patient’s use of tobacco products. Smoking
has been shown to have a negative affect on bone healing and for that reason it
is sometimes preferable to use a patient’s own bone to
encourage bone fusion for patients that smoke.
Q: Can the graft material (bone or plastic) insert get pushed down even more
during activity after the surgery and cause problems on the spinal cord?
A: During the webcast a plastic "spacer" was inserted between the bones of
the spine and it should not move during activity or exercise after surgery. To
assure a good fit of the spacer, the space between the bones is measured and
instruments of different sizes are placed in the space to help determine which
size spacer or bone graft will fit very snugly so that it doesn’t move.
Q: Can this procedure be done on the lumbar (low back) part of spine?
A: Surgery can be very successful in treating low back and/or leg pain
(sciatica) caused by disc problems in the lumbar spine and there are different
procedures performed for the low back conditions.
In some cases the procedure may involve simply relieving the pressure from a
nerve root and in others a fusion is recommended. Determining which procedure is
indicated and the likelihood of success in relieving symptoms is something that
requires an examination of the patient by a physician and also a review of the
studies that have been done for the condition.
Q: I had this operation 18 months ago and still had to wear the most
uncomfortable neck brace. Is this sometimes an option?
A: Generally, for a single level fusion, a brace or collar is not necessary
for most patients. The decision about use of neck brace depends on several
factors including the strength of the patient's own bone (or if the patient has
osteoporosis), use of tobacco products by the patient and how many levels of the
spine are being treated. In cases for which a collar or brace is prescribed, the
type of collar and how rigid it is along with the length of time that its use is
recommended will also vary.
Q: Can chiropractic care help patients that have cervical disc problems like
the one treated during the webcast?
A: In our experience, chiropractic care is something that can be of benefit
to the symptoms of patients with disc herniations.
While in some cases urgent surgical treatment is indicated, unless those
situations exist, our physicians recommend a trial of nonsurgical care.
Nonsurgical care includes things like chiropractic, anti-inflammatory
medications of different types, and therapies.
Q: Are there any age restrictions involved. Too old, too young?
A: There is no solid rule about the age of patient that is eligible for a
cervical fusion.
However, generally surgeons try to avoid doing a fusion for patients that are
very young, (such as their 20s) because doing a fusion can increase the
likelihood of developing problems at another level of the neck and that young
person has many years ahead of them.
Osteoporosis is more commonly seen in older patients, although not all older
patients have the condition. If osteoporosis is present, this has to be taken
into consideration because it can affect how well the bones grow together or
"fuse", but age alone is not usually a factor.
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