Overview
Anterior Cervical Fusion
Once the disc has been removed between the vertebrae, a cervical fusion is performed. This procedure allows the surgeon to fill the space left by removing the disc with a block of bone taken from the pelvis. Placing a bone graft between two or more vertebrae causes the vertebrae to grow together, or fuse
The bone graft is usually taken from the pelvis at the time of surgery, but some surgeons prefer to use bone graft obtained from a bone bank. Bone graft from a bone bank is taken from organ donors and stored under sterile conditions until needed for operations such as spinal fusion. The bone goes through a rigorous testing procedure, similar to a blood transfusion. This is in order to reduce the risk of passing on diseases, such as AIDS or hepatitis, to the recipient.
There are some basic types of spinal fusion:
Anterior Interbody Fusion
This type of fusion is much more common in the neck. This type of fusion is described above. In the interbody fusion, a bone graft is placed between two vertebrae and replaces the removed disc. During the healing process, the vertebrae grow together, creating a solid piece of bone out of the two vertebrae.
Posterior Fusion
You may hear the term posterior fusion as well. In the posterior fusion, the bone graft is placed on the back side of the vertebrae. During the healing process, the vertebrae grow together, creating a solid piece of bone out of the two vertebrae. This type of fusion is only rarely used in the cervical spine, generally only for fractures of the spine. If surgery is necessary, the anterior interbody cervical fusion is used to treat most problems in the neck caused by degenerative disc disease. These include unrelieved neck pain and pressure on the nerve roots caused by bone spurs or a herniated disc.
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. The anterior cervical fusion may also be done in a way that spreads the vertebrae apart a bit, trying to restore the space between them. Increasing the distance between the vertebrae also makes the foramen larger in the back part of the spinal column. This may reduce the pinching and irritation of the nerve roots by bone spurs around the foramen.
Instrumented Cervical Fusion
When doing a cervical fusion, the bone graft may simply be wedged in between the vertebra. It is held there simply because it is wedged in tight. In recent years, there has been an increase in the use of metal plates, screws, and rods to try to increase the success of helping the spine to fuse. Many different types of metal implants are used; all try to hold the vertebrae in position while the fusion heals. Bone heals best when it is held still, without motion between the pieces trying to heal together. The healing of a fusion is no different than healing a fractured bone, such as a broken arm. However, the neck is a difficult part of the body to hold still. In the past, casts and braces were used in an attempt to reduce the motion in the neck and to increase the success rates of a spinal fusion. In most cases, these braces and casts were simply too cumbersome to wear for three months, and did a poor job of actually holding the neck still enough to allow the fusion to heal.
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