Fusion in the Neck
Our cervical spine is made up of seven bones with intervertebral discs between them. The cervical spine has three important roles: it allows the largest degree of movement of any part of the spine, and it has to protect the spinal cord and support the skull. The loads it bears, coupled with the degree of movement can lead to pain in the nerve roots exiting the cervical spine. This is often due to a herniated or degenerated disc.
When conservative measures have failed to alleviate the patient’s pain, the team at Texas Neurosurgery may perform an anterior cervical discectomy and fusion surgery. In this procedure, the disc is removed along with any bone spurs that may have developed as a result of the disc degeneration. Once the disc is removed, the two vertebrae are fused together.
Why is this necessary?
An anterior cervical discectomy with fusion (ACDF) has the goal of relieving pressure on the spinal cord or the nerve roots exiting the spinal cord caused by a cervical spinal disc. The degeneration in the spinal disc may have herniated, where the outer skin develops a crack or tear and the inner gel-like material pushes outward. When the disc pushes outward it often will put pressure on the spinal cord or the nerve roots. This is nerve compression and it causes pain in the extremities served by the impacted nerves. In the neck that means the shoulders, arms, and hands. If the compression is not addressed, the nerves can become damaged and function in the arms and hands may be impacted.
What is the procedure?
For this surgery, the entry is made in the front of the neck, the anterior. A one- to two-inch incision is made. The thin platysma muscle is moved aside. The pre-vertebral fascia, a thin layer of fibrous tissue that encases the spine, is removed, exposing the intervertebral disc in question. To be sure this is the disc that is causing the trouble, we insert a needle into the disc space using x-ray guidance.
Next, we make an incision through the outer shell of the damaged disc, the annulus fibrosus, to access the gel-like nucleus, the nucleus pulposus. We remove all of the inner part of the disc and much of the outer annulus. We may leave a portion of the annulus on the sides of the disc.
If we suspect there are bone spurs in the spinal canal, we may need to remove the ligament at the back of the vertebra to access the spurs or to remove disc material that has pushed through the ligament.
Now, we’re ready for fusion. We insert either a cage or a bone graft into the space where the disc formerly was. This keeps the proper spacing between the vertebrae. Bone graft material allows the bone to grow together to set up a bony bridge/fusion between the upper and lower vertebrae. To stabilize the two vertebrae so they cannot move, we typically attach a small metal plated to the front of the two vertebrae. This precludes any movement between the vertebrae while they fuse together, which can take up to 18 months.
With the damaged disc and any bone spurs removed, the patient should no longer have any pain from nerve compression in the area of the neck. ACDF fusion is a very successful procedure.
Do you have chronic neck, shoulder, and arm pain? You could have problems with your cervical spine. Call the experts at Texas Neurosurgery, (214) 823-2052
, and let’s check out that neck.
, and let’s check out that neck.