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Posterior Cervical Fusion Surgery

What does “Posterior Cervical Fusion” mean?

Here is the meaning of each word:

  1. Posterior: from the back of the neck
  2. Cervical: the area of the spine located in the neck
  3. Fusion: to mend two or more vertebrae together

Altogether, “Posterior Cervical Fusion” means to perform a surgery from the back of the spine to mend vertebrae together.

What is a Posterior Cervical Fusion?

A Posterior Cervical Fusion is a spine surgery done from the back of the neck to stabilize a segment of the spine. During the surgery, titanium screws are placed into vertebrae and connected with titanium rods. Bone or bone like material is placed next to the screws and rods to form a solid bone bridge between the vertebrae over time. Two or more vertebrae can be fused together in this fashion.

Why is a Posterior Cervical Fusion done?

Here are some reasons why Posterior Cervical Fusions are done:

  1. Trauma to the neck which is causing instability between the vertebrae
  2. Following other spine surgeries when the spine is thought to be unstable after bone and ligaments are removed during surgery
  3. Severe Facet Joint Degeneration of the neck
  4. An abnormal curvature in the neck (kyphosis) which is causing severe pain.
  5. Severe spine degeneration which is causing instability of the neck

How is a Posterior Cervical Spine Fusion done?

Here are some of the steps of how a Posterior Cervical Spine Fusion surgery is done:

  1. An intravenous catheter is placed and antibiotics are given before surgery.
  2. This surgery is performed in an Operating Room.
  3. The patient is placed under General Anesthesia while lying on their back (supine)
  4. The patient is then carefully placed on their stomach (prone) on the operating table.
  5. The head and neck are carefully positioned to make the approach for surgery as good as possible.
  6. The back of the neck is now cleaned with a surgical antiseptic and plastic covers (drapes) are placed around the area where the surgery will take place.
  7. The surgeon then makes the initial cut (incision) in the center of the spine.
  8. The softer tissues (fat, fascia) are then divided with a cautery until the tips of the spinous processes (tips of the spine) are seen.
  9. The muscle attachments to the back of the vertebra are then carefully separated from the bone and the muscles pulled to the sides.
  10. X-Rays are taken to make sure the surgeon knows this is the correct level in the spine.
  11. At this point, small titanium screws are place into the bone on the side of the vertebra (lateral mass) with the help of X-Ray machines. Sometimes the spinal cord and spinal nerves are monitored with a nerve monitor (neuromonitoring) to make sure no harm comes to them.
  12. Once the screws are placed, a small titanium rod is chosen to connect them. This provides stability to the area where the lamina bone was removed.
  13. The bones in the area where the screws and rods are located are now intentionally prepared with a burr to make it more likely for the bones to fuse.
  14. The bones which were previously removed from the spine is now made into smaller pieces and placed over the area which was prepared. Sometimes additional materials are placed into this area to make a fusion more likely.
  15. The main part of the surgery is now complete. Additional X-Rays are often taken throughout. A surgical drainage tube is sometimes used.
  16. The retractors are removed and the muscles allowed to fall back over the area where the surgery took place.
  17. The muscles are usually stitched (sutured) back together.
  18. The skin is closed, often with small surgical staples.
  19. A bandage (dressing) is placed over the wound.
  20. Often, a hard brace is put on the neck to protect the area from movement.
  21. The patients is carefully rolled back on their back (supine) and awoken from Anesthesia.
  22. The patient is then brought to the Recovery Room.

How long does a Posterior Cervical Fusion surgery take to complete?

A Posterior Cervical Fusion takes approximately 1.5-3 hours to complete for one spine segment.

What is the recovery like from a Posterior Cervical Fusion?

Here are some of the steps of the recovery from a Posterior Cervical Fusion:

  1. The patient is usually admitted to the hospital for 1-3 days.
  2. A neck brace will often stay in place for much of the time in the hospital and often for 4-6 weeks or more after discharge.
  3. The surgical wound may take 4-6 weeks to fully heal.
  4. The surgeon will restrict the amount of motion in the neck. Typically, the movement in the neck is very limited at least for the initial few weeks.
  5. The patient is often discouraged from taking non-steroid anti-inflammatory medications which could interfere with the fusion.
  6. The patient is discouraged from smoking since it interferes with the fusion.
  7. The surgeon will evaluate the patient and take more X-Rays within a few weeks after surgery.
  8. The restrictions on movement are slowly lifted over time.
  9. The fusion can take 6 months to 1 year to fully develop. This does not mean that the patient will have pain or be very limited in their neck movement during this time.

What type of benefit can patients gain from a Posterior Cervical Fusion?

This depends on why the surgery is done in the first place. The surgery will provide stability to the spine segment.