The goal of spinal fusion is to stop the motion caused by segmental instability. This reduces the mechanical neck pain caused from excess motion in the spinal segment.
Anterior cervical fusions are done through an incision on the front of the neck. The incision length can be as short as an inch and a half but varies based on how many levels are being operated on and the size of your neck.
After making the incision Dr. Paul gently retracts the esophagus, trachea and blood vessels to gain access to the front of your spine. He then removes the disc and removes the disc, or bone. This is done in a manner to relieve pressure on the spinal cord and nerves.
Additional bone and ligament may be released to restore normal height and alignment to the disc space. This is done to improve the long term health of your spine and avoid future surgeries. A cage device sized for the needs of your spine is put into position. A plate and screws are applied at the end of the case to promote a fusion and allow early return to more normal activities.
Your implants are MRI compatible and are not known to set off metal detectors.
How long does it take Dr. Paul to perform the Anterior Cervical Fusion?
Surgery times vary extensively but we can provide some guidelines. One level surgeries require 45 minutes to one hour. Two level surgeries can be one and fifteen minutes to one hour and forty five minutes. Three level surgeries can take 2 to two and half hours. Four hour surgeries can take 2 and half to three hours.
Dr. Paul typically calls the waiting room to update a family member or friend about you briefly. Kevin or Adam will typically check on you in the recovery room and speak to the nurse and Dr. Paul about your recovery. Nursing will let your family know when they can see you.
Please allow an additional hour ½ – two hours if there is additional surgery required from the back.
These times are much higher if you have had prior surgery on your spine. We must emphasize, these are approximate times. These times are much higher if you have had prior surgery on your spine.
Remember, there is substantially more time involved in putting you to sleep, prepping and draping prior to surgery, and more time required to wake you up. As a result, many additional hours are required.
We have attempted to define the more common risks of surgery under each of the procedures outlined. It is impossible to outline all potential poor outcomes, but we have attempted to do so in good faith. It has not been formed as legal protection for us – only to better inform you. Please read them thoroughly.
Infections are a known complication of lumbar surgery. Infection rates are more associated with smoking, poorly controlled diabetes, obesity as well as other health factors. Less invasive and shorter procedures also have lower complication rates. Infections requiring additional surgery are extremely rare in Dr. Paul’s practice.
Bleeding can be a serious complication since blood accumulation can compress the spinal cord or nerve roots. For that reason we require discontinuing blood thinners, some anti-inflammatories and all herbal medications.
Spinal Leaks are a known complication in spine surgery but typically can be managed. They occur approximately 3 to 5% of the time They can be the result of adherent bone, disc, ligament or scar tissue to the dura and the membrane surrounding your nerves or spinal cord. They are far more associated with revision surgery, severe nerve compression and advanced age. If this occurs, we typically repair the leak during your operation. You may be required to lay flat for a short period of time afterwards. Late presenting or persisting spinal leaks can require additional surgery. Spinal leaks typically do not affect long term outcomes.
Neuropraxia & Nerve Injury nerves under pressure can react with pain or increased weakness after being decompressed. These issues are expected and usually resolve with treatment or time. The goal of fusion is to realign and improve the position of the spine which can cause some nerves to be stretched and also induce typically temporary changes. Rarely, these changes are permanent As a precaution, Dr. Paul utilizes a state of the art nerve and spinal cord monitoring system to avoid neurologic problems.
Non-Union not all fusions heal. Some heal as early as three months but many take longer. Some fusions require a year to heal. Dr. Paul’s team gets x-rays regularly during the first year and meets with you to make sure the fusion is successful. Some fusions will require revision surgery to fix the problem.
Medical Complications related to the heart, lung and kidneys and other organs are also a possibility. Although shorter less invasive procedures are associated with lower complication rates, they can still occur. We work closely with your primary care doctor and other specialists to make sure your medical conditions are optimized prior to surgery.
How Do People Function After Cervical Fusion?
The average person does not notice a significant loss of motion from day to day. The exception would be people involved with significant overhead activities, such as tradespeople. People with pre-existing stiffness are more likely to notice a substantial loss of motion. Any loss is usually related to flexion and extension.
The rotational movement (often associated with driving) is less frequently affected since much of that motion comes from between the skull, first and second vertebral bodies.
It is not uncommon to feel mildly depressed or anxious for the first 4-6 weeks of surgery, but those feelings should go away as your daily activities and exercise resume. This is more common with larger or multilevel surgeries. If the depression continues, please consult with your primary care doctor.
It’s especially essential to maintain or improve motion through your hips, knees, and upper back after a lumbar fusion. Flexibility, core strengthening, and an emphasis on function during the postoperative course helps to optimize your motion.
Will the fusion affect the health of the rest of my spine?
Most of the surgeries performed by Dr. Paul are for degenerative conditions like a herniated disc, spinal stenosis. If you have had surgery at one level in your spine, it would be reasonable to assume you could have problems at the same or other levels. Since the spine has 36 levels, this is not unusual. Most people handle degenerative difficulties with self-care and non-operative care. That being said, Dr. Paul and his team go to great lengths to minimize the chances of needing additional care for your spine. That includes careful surgical planning, intraoperative decision making, and post-operative care.
You may return to light duty or physical labor if pain-free and allowed by your surgeon. You may drive up to one hour. You may swim if allowed by your surgeon. Continue your physical therapy exercise program. You may be shown specific therapeutic exercises at your six-week visit.
Preparing For Surgery
Things to do Leading up to Surgery
Optimization For Spinal Surgery
Before undergoing surgery, Dr. Paul and his team will work with your primary care provider and other specialists to optimize your health to minimize the risk of complications.
People who have had cardiac interventions such as stents, ablations and surgery or a history of significant cardiac diagnoses will need to see their cardiologist prior to surgery. Your cardiologist may require additional testing or interventions prior to surgery.
We require all patients undergoing spine surgery to quit smoking two weeks prior to surgery. Nicotine is a significant risk factor for many complications, including infections, recurrent nerve problems, fusions failure, and others. Click here for more information and support.
A BMI over 35 is associated with major complications from spine surgery. Your pain and recovery are also adversely impacted by excess weight. If your BMI is over 35 we postpone surgery because the weight must be improved. We are happy to offer additional help from our weight loss clinic. For more information, see our DMG weight loss clinic by clicking here.
Supplements to Begin Before Surgery
We recommend all our patients start the following regimen of supplements two weeks prior to surgery. There is some evidence that they improve wound healing and bone healing (if fusion is required).
Calcium is essential for normal bodily functioning. If not received in great enough quantities, the body will look to mobilize other sources, namely the bones. Naturally, this leads to weakening of the skeletal system, and increases the risk of injury. Adults should aim to consume approximately 1000 mg of calcium per day.
Necessary for the formation of collagen, vitamin C is another essential supplement if normal daily intake is inadequate. Collagen is used in bone building and supports the skeletal system in connective tissues. A recommended daily dosage is at least 1000 mg.
Another crucial vitamin for healthy bones, vitamin D aids in calcium absorption. Inadequate levels can lead to thin or brittle bones prone to damage. Optimal daily intake for adults is approximately 1000 IU.
2-4 Weeks Before Surgery
Attend PCP appointment
Choose Your Coach (see below for suggestions):
If recommended by your surgeon, see your current specialists for medical clearance
If you are a smoker, you should stop using tobacco products. Please read information about
Stop all herbals and supplements, vitamins, and appetite suppressants 14 days before surgery
Stop non-steroidal anti-inflammatory medications (NSAIDs) such as Motrin, ibuprofen, Advil, Aleve, Naproxen, and others 10 days before surgery
Stop taking herbals, Vitamin E, Fish Oil, 14 days before surgery
Stop taking appetite suppressants 14 days before surgery