Introduction

Posterior cervical fusion is done through the back (posterior) of the neck. The surgery joins two or more neck vertebrae into one solid section of bone. The medical term for fusion is arthrodesis. Posterior cervical fusion is most commonly used to treat neck fractures and dislocations and to fix deformities in the curve of the neck.  Surgeons sometimes attach metal hardware to the neck bones during posterior fusion surgery. This hardware is called instrumentation.

What do surgeons hope to achieve?

Posterior cervical fusion is used to stop movement between the bones of the neck. A serious fracture or dislocation of the neck vertebrae poses a risk to the spinal cord. The spinal cord is sometimes damaged by the fractured or dislocated bones. Surgeons hope to protect the spinal cord from additional injury by fusing these bones together.

Surgeons also use posterior cervical fusion to help patients who have mechanical neck pain. Extra movement within the parts of the cervical spine can be a source of this type of neck pain. Fusing these bones together prevents the extra movement, easing pain.

Posterior fusion is also used to line up and hold the neck bones when there's a deformity in the curve of the neck. Normally, the neck lines up with a slight inward curve from the base of the skull to the top of the thorax (the chest area). One type of deformity that changes the curve of the neck is called kyphosis. This happens when the inward curve starts to bow outward. Some people are born with an outward bow in their neck. Kyphosis can also occur when a severe injury compresses the vertebral body into the shape of a wedge. Neck surgeries that weaken the bony ring around the spinal canal can also lead to kyphosis. When kyphosis is a problem, a posterior fusion procedure may be used to correct the curve and to fuse the bones together once they're in the right position.

How will I prepare for surgery?

The decision to proceed with surgery must be made jointly by you and your surgeon. You should understand as much about the procedure as possible. If you have concerns or questions, you should talk to your surgeon.

Once you decide on surgery, your surgeon may suggest a complete physical examination by your regular doctor. This exam helps ensure that you are in the best possible condition to undergo the operation.

On the day of your surgery, you will probably be admitted to the hospital early in the morning. You shouldn't eat or drink anything after midnight the night before.

Surgical Procedure

Patients are given a general anesthesia to put them to sleep during most spine surgeries. As you sleep, your breathing may be assisted with a ventilator. A ventilator is a device that controls and monitors the flow of air to the lungs.

This surgery is usually done with the patient lying face down on the operating table. The surgeon makes an incision down the middle of the back of the neck. Retractors are used to gently separate and hold the neck muscles and soft tissues apart so the surgeon can work on the back of the spine.

A layer of bone is shaved off the surface of the outer ring (the lamina) of each vertebra to be fused. This causes the surface to bleed and to stimulate the bone to heal. (This is similar to the way the two sides of a fractured bone begin to heal.) Small strips of bone are grafted from the top part of the pelvis and laid over the back of the spinal column. This bone graft also helps stimulate the bones to heal together, or fuse.

The muscles and soft tissues are put back in place, and the skin is stitched together. Most patients are placed in a rigid neck collar to lock the bones firmly in place.

What are the risks?

As with all major surgical procedures, complications can occur. Some of the most common complications following posterior cervical fusion include

•problems with anesthesia

•thrombophlebitis

•infection

•nerve damage

•problems with the graft

•nonunion

•ongoing pain

After Surgery

Most patients are placed in a rigid neck brace after surgery for several months. These restrictive measures may not be needed if the surgeon attached metal hardware to the spine during the surgery.

Patients usually stay in the hospital after surgery for up to one week. But they can start to get up as soon as they feel up to it. Patients are watched carefully when they begin eating. They usually drink liquids at first. If they are not having problems, they can go on to solid food.

A physical therapist will schedule daily sessions to help patients learn safe ways to move, dress, and do activities without putting extra strain on the neck.

Patients are able to return home when their medical condition is stable. However, they are usually required to keep their activities to a minimum in order to give the graft time to heal. Outpatient physical therapy is usually started four to six weeks after the date of surgery.

Rehabilitation

Rehabilitation after posterior cervical fusion can be a slow process. If the spinal cord was injured from a neck fracture or dislocation, patients may need intensive and ongoing rehabilitation for the neurological condition. When the spinal cord has not been damaged, patients may need to attend therapy sessions for two to three months and should expect full recovery to take up to eight months.

Many surgeons prescribe outpatient physical therapy beginning a minimum of four weeks after surgery. At first, treatments are used to help control pain and inflammation. Ice and electrical stimulation treatments are commonly used to help with these goals. Your therapist may also use massage and other hands-on treatments to ease muscle spasm and pain.

Active treatments are slowly added. These include exercises for improving heart and lung function. Walking and stationary cycling are ideal cardiovascular exercises. Therapists also teach specific exercises to help tone and control the muscles that stabilize the neck and upper back.

Your therapist also works with you on how to move and do activities. This form of treatment, called body mechanics, is used to help you develop new movement habits. This training helps you keep your neck in safe positions as you go about your work and daily activities. At first, this may be as simple as helping you learn how to move safely and easily in and out of bed, how to get dressed and undressed, and how to do some of your routine activities. Then you'll learn how to keep your neck safe while you lift and carry items and as you begin to do other heavier activities.

As your condition improves, your therapist will begin tailoring your program to help prepare you to go back to work. Some patients are not able to go back to a previous job that requires heavy and strenuous tasks. Therapists often help as a resource to suggest changes in job tasks that may enable you to go back to your previous job or to do alternate forms of work. You'll learn new ways to do these tasks in ways that keep your neck safe and free of extra strain.

Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems.