Anterior Cervical Fusion

 
Anterior cervical fusion involves surgery on the front of the neck to fuse two vertebrae together after decompression of the nerves.

This surgery is performed to decompress compressed nerve roots of spinal cord in the neck. The spine is approached from the front. The appropriate disc or discs are removed to gain access to the spinal canal. Prolapsed disc material is removed as well as any bony spurs that might be compressing the spinal cord or nerve roots. The disc space is then filled with a bone graft and a titanium plate is applied across the disc space to hold the vertebrae together while fusion is taking place.

 

 

Post operative course

The average hospital stay is 1-3  days. Some patients need longer. Some pain is experienced in the front neck wound though it is usually quite moderate. If a bone graft is taken fromthe hip this is usually the most painfull. The worst pain is over in 48 hours. Modern post-operative pain relief, however, is  very effective and patients are usually quite comfortable with the use of a patient controlled analgesia device (PCA). A wound drain is inserted at the time of surgery and this is removed on the day after surgery.
 
If a PCA is used it is usually removed after 24 - 48 hrs. SOme difficulty is normally experienced with swallowing and for the first few days soft foods are recommended.  At the time of discharge patients are normally independantly mobile, though slow and still sore from the bone graft site. After discharge exercises provided by the physiotherapist should continue. Most recovery occurs over a 2-3 week period though it may take another 1-2 months to recover fully.

 

Possible complications
 
All surgery has risks potential benefits need to be balanced against the potential for complications. Generally, as with any surgery, these are:
 
  • Superficial wound infection
  • Risk of clots (deep venous thrombosis) - possible causing pulmonary embolism (the clot travelling to the lungs with occasional fatal consequences)
  • Deep wound infection
  • Risk of precipitating age-related medical problems in individuals prone to the problem such as heart attack or stroke (rare)
  • Drug allergy to anaesthetic agents - occasionally very serious.
 
For this surgery in particular these complications are:
 
  • There is a specific risk of damage by stretching of a nerve to the voice box. This is uncommon though if it occurs there is a risk of developing a hoarse voice. If it does occurr most case resolve spontaenously in a relatively short period of time. Though it recovery can take up to 12 months. There is a risk however that the hoarse voice may be permenant. In this rare situation surgery by an ENT surgeon may improve the voice.
  • Persisting difficulty swallowing. It is normal to have some trouble swallowing after the surgery though occasionally this can persist. Very rarely it can be quite troublesome.
  • Nerve damage - causing either weakness in some muscles in one or both arms (very uncommon).If this does occur recovery usually occurs in weeks or months. There is howver a very small chance of permenant weakness.
  • Post-operative bleeding around spinal cord (epidural heamatoma) causing compression and the need for further surgery (very rare).
  • Implant failure /  malplacement requiring a return to the operating theatre to re-position the screws.
  • Fracture or failure of implants (very rare)

 

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