Overview and Benefits
Neck spine fusion and removal is a surgical procedure used to treat slipped or ruptured disc in the neck. Cervical (neck) discs act as shock absorbers. They stabilise the neck and allow it to move smoothly and bend forward and backward.
There are 23 discs in the spinal column. Six of them are in the neck. Each is located in between the cervical vertebrae that are stacked onto each other. These discs are made up of soft, gelatin-like inner portion protected by a tough outer covering. A slipped disc occurs when the outer ring becomes damaged or weak. As a result, the gelatin-like inner portion slips out. This causes pain, numbness, and weakness in the neck. These symptoms can also be felt in the hands, arms, and chest.
The procedure removes the damaged disc. The empty space is then filled with a bone graft. This allows the bones above and below the space where the damaged disc used to be to fuse together.
Who Should Undergo and Expected Results
Other than slipped cervical discs, other conditions that may require neck spine fusion include bone fractures that make the spinal cord unstable. It can also be used if the cervical vertebrae are not aligned or have been deformed. It is important to note that surgery is not the first form of treatment for such conditions. Initial treatment includes pain medications and physical therapy. Surgery becomes an option when the condition fails to improve after months of noninvasive treatment.
The procedure is very effective in fusing the bones on top and below the affected disc. This provides pain relief. It also allows patients to regain their neck’s normal range of motion.
The surgery is an outpatient procedure. This means that patients are allowed to go home the same day. However, in some cases, they may need to stay in the hospital overnight. This is required if there are complications. These include difficulty breathing. Those with unstable blood pressure are also closely monitored before they are discharged. Patients may be allowed to go back to work four to six weeks after the surgery.
How is the Procedure Performed?
The procedure can be carried out by an orthopaedic surgeon or a neurosurgeon. There are certain factors that need to be decided before the procedure. The most important is the type of graft that will be used. Options include a bone graft taken from the patient’s hipbone. A graft from a bone bank or an artificial disc replacement can also be used.
The patient also meets with an anaesthesiologist before the procedure. The doctor will explain the type of anaesthesia to be used and its possible risks. During the procedure, the patient lies on his or her back on the operating table. General anaesthesia is then administered. This allows the patient to sleep throughout the procedure. They will not feel any pain or discomfort.
Once the anaesthesia takes effect, the surgeon will make an incision in the neck. The supporting muscles are then moved aside to access the damaged cervical discs. This is done with the use of a special retractor.
The surgeon will proceed by removing the damaged disc as well as any materials that are compressing the nerve root. A compressed nerve root is one of the main causes of chronic neck pain.
The bone graft is then placed in the space where the damaged disc used to be. The surgery will take longer if the bone graft is taken from the patient’s hipbone. To ensure that the graft stays in place until the bones are fused, it is supported with metal plates and screws. After the procedure, the patient undergoes an x-ray. This helps the surgeon confirm the position of the graft, screws, and plates.
After surgery, patients are monitored for any possible complications. Their respiration, heart rate, and blood pressure are checked. They are also given pain medications. Pain relievers are very important especially for those who have had bone graft taken from their hip. If there are no signs of complications, patients are sent home. They are prescribed with narcotic pills that they can take for a period of two to four weeks. They may also need to wear a neck brace until they are fully recovered.
Patients are advised to call their doctor immediately if their incision shows signs of infection. They must also call if they suddenly develop a high fever and severe swallowing problems that prevent them from breathing or drinking water properly.
Patients are advised to make a follow-up two weeks after the surgery. The surgeon will check their surgical wound to make sure that it is healing well. Patients are also asked if they develop any complications. If needed, they are treated for their symptoms.
Possible Risks and Complications
As with any other surgical procedure, neck spine fusion and removal has risks and complications. These include voice hoarseness, swallowing difficulties, and nerve damage. The hardware that holds the bone graft in place can also break. This can be a serious problem if it happens when the bones are not yet fully fused. In addition, there are a few cases where the vertebrae fail to fuse. Common causes are malnutrition, smoking, and obesity.
Xie JC, Hurlbert RJ. Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation: a prospective randomized study. Neurosurgery 61:107-16, 2007.
North American Spine Society (February 2013), “Five Things Physicians and Patients Should Question”, Choosing Wisely: an initiative of the ABIM Foundation, North American Spine Society