Introduction

Posterior cervical fusion surgery joins two or more neck vertebrae into one solid section of bone. Posterior cervical fusion is most commonly used to treat neck fractures and dislocations and to fix deformities in the curve of the neck.

Doctors sometimes attach metal hardware to the neck bones during posterior fusion surgery.

Anatomy

Doctors perform this surgery through the back part of the neck. The muscles on the back of the neck cover the bony ring around the spinal cord, the pedicles and laminae.

The spinal canal is a hollow tube formed by the bony rings of all the vertebrae. The spinal canal surrounds and protects the spinal cord within the spine. In particular, the lamina bones act like a protective roof over the back of the spinal cord. Facet joints line up on both sides along the back of the spinal column.

Rationale

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. Doctors hope to protect the spinal cord from additional injury by fusing these bones together.

Doctors 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 helps prevent 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 chest. 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.

Surgical Procedure

You will most likely be given a general anesthetic to put you to sleep during surgery. As you sleep, your breathing may be assisted with a ventilator.

This surgery is usually done with the patient lying face down on the operating table. The doctor 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 doctor 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.

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 attaches metal hardware to the spine during the surgery.

Patients usually stay in the hospital after surgery for up to one week. But they can get up as soon as they feel up to it. Patients are watched carefully when they begin eating. They usually drink liquids at first, and 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 or longer, depending on the individual.