Anterior Cervical Fusion
What Is It?
Anterior cervical fusion is an operation performed on the upper spine to relieve pressure on one or more nerve roots, or on the spinal cord. The term is derived from the words anterior (front), cervical (neck), and fusion (joining the vertebrae with a bone graft).
Why is it Done?
When an intervertebral disc ruptures in the cervical spine, it puts pressure on one or more nerve roots (often called nerve root compression) or on the spinal cord, causing pain and other symptoms in the neck, arms, and even legs. In this operation, the surgeon reaches the cervical spine through a small incision in the front of the neck. After the muscles of the spine are spread, the intervertebral disc is removed and is replaced with a small plug of bone, which in time will fuse (join) the vertebrae it lies between.
Obtained from a bone bank, the preformed bone plug will not be rejected by your body because it is avascular (contains no blood cells). In some circumstances, or at the preference of your surgeon, the bone plug might instead be removed from your own hip through a second incision.
What Happens Afterwards?
Successful recovery from anterior cervical fusion requires that you approach the operation and recovery period with confidence based on a thorough understanding of the process. Your surgeon has the training and expertise to correct physical defects by performing the operation; he and the rest of the health care team will support your recovery. Your body is able to heal the involved muscle, nerve, and bone tissues. Full recovery, however, will also depend on you having a strong, positive attitude, setting small goals for improvement, and working steadily to accomplish each goal.
Anterior Cervical Fusion: The Operation
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).
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).
The operation is completed when the neck incision is closed in several layers (Fig. 7). Unless dissolving suture material is used, the skin sutures (stitches) or staples will have to be removed after the incision has healed.
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.