Cervical Spine Fusion

How is it performed?

A cervical spinal fusion is a surgical procedure used to fuse two or more vertebrae together to create a stable unit to limit movement of painful, damaged vertebrae. Because your cervical spine needs to be accessed during a cervical spinal fusion, an open procedure will be performed in which an incision several inches in length is made along the front or back of your neck to access the affected vertebrae. The disc between the affected vertebrae will be removed and replaced with a bone graft implant to maintain the proper height of your spine. The vertebrae and the implant will then fuse together over time.

Graft Decision

To create a bone graft, an implant called an interbody cage will be used to act as the framework. Interbody cages are most commonly made of titanium metal or a substance called polyetheretherketone (PEEK) that has similar properties to bone. 

The openings within the interbody cage are filled with grafted bone to complete the bone graft implant to replace a spinal disc and act as a spacer between the vertebrae that are being fused together. This bone can either be obtained from your own body or from a donor. Choosing between which type of graft to use will be a decision made by you and your surgeon. 

Autograft

An autograft is a graft obtained from your own body. Most commonly, a portion of bone is removed from the iliac crest, the upper rim of your hip bone. An autograft is the “gold standard” type of graft for cervical spinal fusions due to the improved ability of your body to fuse its own bone cells together in order to heal. Because using an autograft requires additional surgery at your hip bone, you may experience additional pain at the graft site. Autografts are particularly beneficial for multilevel spinal fusions and tend to fuse vertebrae together faster than allografts.

Allograft

An allograft is a graft obtained from a cadaver donor. Because this type of bone graft is not obtained from living bone cells, an allograft acts as a scaffold that allows new bone cells to grow through its surface and eventually replace the bone graft over time. Allografts have relatively equivalent fusion rates compared to autografts for single level spinal fusions, but may take longer for the vertebrae to fully fuse together.

Surgical Technique

The surgical technique used to fuse your vertebrae bones together with a cervical spinal fusion can vary depending on which areas of your cervical spine need to be accessed and fused together. The majority of cervical spinal fusions are performed through making an incision along the front of the neck to better access the discs between the vertebrae. 

Cervical spinal fusions through the front of the neck are also more ideal for accessing multiple levels of the vertebrae, whereas procedures through the back of the neck are typically used for accessing only one or two levels. For some cases, both the front and back of the neck will need to be accessed in order to successfully complete a cervical spinal fusion. Your surgeon will decide which surgical technique is most appropriate for you during your cervical spinal fusion depending on what areas of your cervical spine require treatment.

Anterior Cervical Discectomy and Fusion (ACDF) 

An anterior fusion is the most common surgical approach for a cervical spinal fusion where your surgeon will operate from the front (anterior) of your neck. You will lay on your back on the operating table while an incision will be made through the front of your neck along the border of your sternocleidomastoid (SCM) muscle. The disc between your vertebrae will be removed from the front of your neck and an implant will be placed between the vertebrae. Metal plates may be used to attach the front portions of the vertebrae together for added stability. 

Posterior Cervical Fusion (PCF)

A posterior fusion involves operating from the back (posterior) of your neck. You will lay on your stomach on the operating table while an incision will be made down the back of your neck to access your vertebrae. The laminae of the vertebrae will be removed and the facets of the vertebrae will be trimmed down to access the inner portion of the vertebrae. The nerve roots surrounding the affected vertebrae will carefully be moved out of the way while the disc between your vertebrae will be removed from the back of your spine. An implant will be placed between the vertebrae while rods and screws will be placed through the pedicles of the vertebrae to stabilize and hold the vertebrae together. 

Combined Anterior and Posterior Technique

A combined approach for a cervical spinal fusion involves operating from both the front and back of your neck, requiring you to be flipped over on the operating table during the surgery. A combined approach is used to fuse and stabilize multiple levels of the cervical vertebrae in your neck with incisions made along the front and back of your neck to complete both an anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF). 

Surgery Recovery Timeline

Full recovery from a cervical spinal fusion can take between 3-6 months to return to unrestricted activity. If you have a sedentary job, you can generally return to work 4-6 weeks after your surgery. Jobs that require more physical activity can require you to take off 12 weeks or more depending on your progress with rehabilitation and how physically demanding your job duties are.