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ANTERIOR
CERVICAL FUSION
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| Incision |
 Surgery for anterior cervical fusion
is performed with the patient lying on his back. A small incision is
made in the front of the neck, to one side
(Fig. 2).
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Exposure
and
Removal of the
Cervical Disc |
After a retractor is used to
pull aside fat and muscle, the disc is exposed between the vertebrae.
Part of it is removed with a forceps (Fig. 3).
Then a surgical drill is used to enlarge the disc
space (Fig. 4), making it easier for the surgeon to empty
the intervertebral space fully and remove any bone spurs. Afterwards,
only a single ligament separates the surgical instruments from
the spinal cord and nerve roots.
Placement of the Bone Graft
The bone graft is placed in the disc space, where
it will begin to fuse the vertebrae it lies between (Fig. 5).
Adding Stability: Fusion
In fusion, your doctor joins (fuses) the vertebrae
above and below the removed disk. Fusion is done with a bone graft,
but occasionally metal plates are added. Metal plates add stability
to the cervical spine and aid in the healing process (Fig. 6).
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| Incision
Closure |
 The
operation is completed when the neck incision is closed in several layers.
Unless dissolving suture material is used, the skin sutures (stitches)
or staples will have to be removed after the incision has healed. Click
on the picture to enlarge it.
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| X-Rays |
X-Rays are taken to verify the position
of the instrumentation. Below is a patient with a two level cervical
fusion.
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Click on the X-rays to enlarge them. |
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| Risk |
Certain risks must be considered
with any surgery. Although every precaution will be taken to avoid complications,
among the most common risks possible with surgery are: infection, excessive
bleeding (hemorrhage), and an adverse reaction to anesthesia.
Other risks possible when anterior cervical fusion
include: stroke, injury to the recurrent laryngeal nerve, which
causes hoarseness and may or may not be permanent; and injury to
the involved nerve root(s) or the spinal cord, both of which can
cause varying types and degrees of paralysis.
Clinical experience and scientific calculation
indicate that, in general, surgical risks are limited; however,
surgery is a human effort. Unforeseen circumstances can complicate
any surgical procedure and lead to serious or even life-threatening
situations. Although such complications are rare, you should feel
free to discuss the question of risk with your doctor.
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Hospital
Recovery
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Pain |
It is normal to have pain
after the operation, especially in the incision area. This does not mean
that the procedure was unsuccessful or that your recovery will be slow.
Pain in the neck or arms is also not unusual, caused by inflammation
of the previously compressed nerve. It will slowly lessen as the nerve
heals. Medication will be given to control pain. Moist heat and frequent
repositioning may also help. |
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| Numbness |
Numbness or tingling sensations
are often the last symptoms to leave. Numbness which lingers in parts
of the arm or fingers usually is no cause for worry and should gradually
go away. |
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| Physical
Activity |
You may move about in bed and
rest in any comfortable position when you have recovered from anesthesia.
Walking may begin within several hours. The easiest way for you to get
out of bed is to raise the head of the bed as far as it will go, and
then swing your legs to the floor. Avoid pulling up from a flat position
with the trapeze.
The doctor may order a cervical collar to be worn
whenever you are up and about. Your nurse will explain its proper
use and help with any activity.
Gradually increase the amount of walking you do
each day. Since it may at first be painful, try making short trips.
Begin with a trip to the bathroom, then to the door, and later
out into the corridor.
Sitting and standing also require a gradual pace.
If discomfort occurs, change positions frequently.
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| Hygiene |
Usually you may take a shower
the day after surgery. This will make you feel better and should be done
with the dressing left in place to protect the incision. Your nurse will
change the dressing afterwards. |
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| Nutrition |
Intravenous (I.V.) fluids
will be ordered during the early recovery period and continued until
you can tolerate regular liquids without nausea or vomiting. Your diet
will then be adjusted back to normal as your appetite returns. Constipation
will be treated with laxatives and a diet of whole grain cereals, fruits,
and fruit juices. |
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| Emotional
Changes |
It is normal to feel discouraged and
tired for several days after surgery. These feelings may be your body's
natural reaction to the cutback of extra hormones it put out to handle
the stress of surgery. Although emotional let-down is not uncommon, it
must not be allowed to get in the way of the positive attitude essential
to your recovery and return to normal activity. |
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| Discharge
from the Hospital |
The hospital stay for anterior cervical
fusion patients usually lasts 1 or 2 days. This will be determined by
your progress and by the amount of comfort and help available to you
at home. |
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Home
Recovery
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| Physical
Activity |
Daily walking is the best exercise. Try
to increase your distance a little each day, setting a pace that avoids
fatigue or severe pain. You may climb stairs when you feel able.
Sexual relations may be resumed during the recovery
period, but positions that strain the neck or cause pain should
be avoided.
"Listen" to your body. Discomfort is normal while
you gradually return to normal activity, but pain is a signal to
stop what you are doing and proceed more slowly.
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| Working |
Your doctor will help determine when
you can return to work and with what limitations. If a work release is
required, it will be given to you during the first post-operative visit. |
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| Driving |
Drive a car only when you have recovered
full coordination and are experiencing minimal pain. Do not drive after
taking pain medication. |
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| Medication |
You should gradually use less pain medication
while recovering at home. This can be accomplished by increasing the
amount of time between taking pills, then by reducing the number taken
each time. A certain amount of discomfort and pain in the neck and arm(s)
can be expected until the inflammation and nerve sensitivity have subsided.
Heat, exercise, massage, and short rest periods will also help relieve
pain. |
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| Hygiene |
If the skin sutures were removed before
your discharge from the hospital, it is not necessary to keep the incision
covered. Unless instructed otherwise, you may take a daily shower or
tub bath, which will help you feel better. Let the water run over the
incision, but do not scrub or rub over it. Pat it dry. After bathing,
massage lotion over the tightened neck muscles. |
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| Inflammation |
If you notice increased redness, swelling,
or any drainage around the incision after leaving the hospital, notify
your doctor. |
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| Nutrition |
A well balanced diet is necessary for
proper healing. Include foods from each basic food group: dairy products,
meats, vegetables, and fruits. Since you will be less active during recuperation,
avoid rich, heavy foods and those high in calories but low in nutrients. |
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Healing
and Recovery
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| Healing |
Healing is the body's natural process
of restoring its damaged tissues to a normal or nearly normal state.
Although healing may be improved by general good health, proper nutrition,
rest, and physical fitness, it will occur without your having to work
at it. |
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| Recovery |
Recovery is the process
during which you work to become well. It requires a gradual but persistent
effort to increase physical strengths and minimize weaknesses. You must
concentrate on what is improving, rather than on what symptoms remain.
This focus on progress that has been made, combined with the constant
effort to improve, make up the positive attitude that will speed your
return to normal daily activity. |
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Making
Sure You Understand
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Test your knowledge of anterior
cervical fusion by answering the following questions.
- What is a herniated disc? How can it cause neck and arm pain?
- What is the bone plug used for? Why isn't it rejected by
your body?
- Why, after surgery, is there still pain in the neck or arms
- sometimes even temporarily worse than before surgery?
- After the operation, how soon may you return to normal physical
activity?
- When should you wear the cervical collar? Why?
- What will help relieve pain besides medication?
- What is the difference between healing and recovery? How
does a positive attitude affect each?
- Are you comfortable with your understanding of the risks
of this procedure? Do you realize the part human effort plays
in its expected outcome?
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The human body is an intricate
network of interrelated systems. Each system functions on its own but
is also influenced by and dependent upon the others. When illness or
injury occurs, it disrupts the function of one or more of these systems.
Surgery is a human effort
made to correct one system's malfunction, but it will affect all
others. Because of this complex interrelationship, surgical outcomes
cannot be predicted.
When recovery is possible,
it occurs as a combination of the surgeon's effort, the patient's
faith, and a positive acceptance of the outcome.
 Review stories of patient's
who have had an Anterior Cervical Discectomy and Fusion.
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The
information in eSpine.com is not intended as a substitute for medical
advice but is to be used as an aid in understanding back pain and neck
pain. Always consult your physician about your medical condition.
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All
content and images © 1999-2009 eSpine, Inc.
Last updated: November 9th, 2009
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