Cervical Spinal Fusion

Overview

Cervical spinal fusion generally refers to a surgical procedure that joins two or more vertebrae in the neck to reduce motion and improve stability. It may be considered when cervical spine instability, nerve compression, or structural problems can contribute to pain, neurologic symptoms, or spinal cord dysfunction. The procedure typically uses bone graft material and often uses plates, screws, rods, or cages to support alignment while fusion develops. Outcomes can include reduced painful motion and improved neurologic function in selected conditions, although symptom relief and fusion rates can vary by diagnosis, approach, and patient factors.

Indications

This procedure may be considered when:

• •Cervical radiculopathy from degenerative disc disease or foraminal stenosis that may persist despite non-surgical management and correlates with imaging findings
• •Cervical myelopathy from spinal cord compression (often due to spondylosis, disc-osteophyte complex, or ligament changes) where stabilization and/or decompression may be needed
• •Cervical spine instability, including spondylolisthesis or segmental instability that can contribute to pain or neurologic symptoms
• •Traumatic cervical fractures or dislocations where stabilization may be required to protect neurologic structures and maintain alignment
• •Cervical deformity (such as kyphosis) where fusion may be used to restore or maintain alignment and reduce progressive deformity
• •Tumor, infection, or inflammatory conditions that can weaken vertebrae and may require stabilization after debridement or decompression
• •Revision surgery for failed prior cervical surgery, pseudoarthrosis (nonunion), or recurrent compression where additional stabilization may be considered

How It Works

The procedure typically involves several coordinated steps:

• •Preoperative planning typically uses X-ray, CT, and/or MRI to identify symptomatic levels, evaluate alignment, and assess spinal cord or nerve root compression
• •An anterior cervical discectomy and fusion (ACDF) approach often involves removing the intervertebral disc and osteophytes to decompress neural structures and prepare endplates for fusion
• •A posterior approach can involve laminectomy, laminoforaminotomy, or facetectomy as needed for decompression, followed by fusion using lateral mass or pedicle screw fixation depending on anatomy and surgeon preference
• •Bony surfaces are generally decorticated (lightly roughened) to promote bleeding bone and improve the biologic environment for fusion
• •Bone graft material may include autograft, allograft, or bone graft substitutes; selection can vary based on clinical context and risk factors for nonunion
• •Interbody devices (such as cages) can help restore disc height and cervical lordosis and can provide a scaffold for bone growth in anterior procedures
• •Instrumentation (plates, screws, rods) typically provides immediate mechanical stability and can reduce micromotion that may interfere with fusion biology
• •Alignment is often assessed intraoperatively with fluoroscopy to confirm level selection, sagittal balance, and implant positioning
• •Hemostasis is achieved to reduce postoperative hematoma risk, and a drain may be placed when soft-tissue oozing is anticipated
• •Soft tissues are closed in layers to restore anatomic planes, and the skin is closed with sutures, staples, or adhesive
• •Postoperative protocols often include activity modification and sometimes a cervical collar depending on approach, number of levels, and fixation strategy
• •Fusion biology typically progresses over months as bone forms across the intended fusion site, and imaging follow-up can help assess alignment and fusion development

Risks

As with any surgical procedure, potential risks include:

• •Infection (superficial or deep), which can present with wound drainage, fever, increasing pain, or elevated inflammatory markers and may require additional treatment
• •Bleeding or postoperative hematoma, which can be clinically important in the neck because swelling may affect swallowing or breathing, particularly after anterior approaches
• •Nerve root injury or spinal cord injury, which can lead to new weakness, numbness, gait changes, or bowel/bladder dysfunction depending on severity and level
• •Dysphagia (difficulty swallowing) and hoarseness, which can occur after anterior approaches due to soft-tissue retraction or irritation of the recurrent laryngeal nerve and often improves over time but can persist in some cases
• •Nonunion (pseudoarthrosis), where intended bone fusion may not fully develop, potentially contributing to persistent pain or hardware stress and sometimes requiring revision surgery
• •Adjacent segment degeneration, where levels above or below the fusion can experience increased mechanical stress over time and may develop new symptoms
• •Hardware-related complications such as screw loosening, plate displacement, rod breakage, or implant subsidence, which can affect alignment or neural decompression
• •Cerebrospinal fluid leak (dural tear), which can occur during decompression and may cause headaches or require repair
• •Blood clots (deep vein thrombosis or pulmonary embolism), which can occur after major surgery, particularly with reduced mobility
• •Anesthesia-related complications such as nausea, cardiopulmonary events, or allergic reactions, with risk influenced by overall health status

Recovery Expectations

Recovery follows a gradual progression:

• •First 24–72 hours: Monitoring typically focuses on pain control, neurologic status, wound assessment, and (for anterior approaches) swallowing and voice changes; discharge timing can vary by approach and number of levels
• •First 1–2 weeks: Incision healing and gradual increase in walking and light daily activities often occur; soreness and muscle spasm can be common during this span
• •Weeks 2–6: Activity restrictions often remain in place, and some patients may use a cervical collar during this period depending on surgeon protocol and fixation strategy
• •Weeks 6–12: Many patients can often resume a broader range of daily activities; physical therapy may be introduced or progressed to support posture, shoulder girdle strength, and neck mechanics as permitted
• •Months 3–6: Fusion maturation can continue, and imaging may be used to assess alignment and signs of bone healing; some patients can generally return to heavier activities during this span depending on job demands and symptoms
• •Months 6–12: Bone fusion can continue to consolidate, and residual stiffness is common because motion at fused levels is reduced; symptom improvement can continue gradually
• •Beyond 12 months: Long-term follow-up may focus on function, adjacent segment symptoms, and hardware status when clinically indicated

Alternatives

Depending on individual circumstances, alternatives may include:

• •Activity modification and structured physical therapy focusing on posture, cervical stabilization, and symptom-guided strengthening
• •Medications that can manage pain or inflammation (for example, nonsteroidal anti-inflammatory drugs) when appropriate for the individual clinical context
• •Epidural steroid injections or selective nerve root blocks for radicular pain in selected cases, typically as part of non-surgical management
• •Cervical disc arthroplasty (artificial disc replacement) for selected patients with disc-related radiculopathy or myelopathy at specific levels, where motion preservation may be an option
• •Posterior cervical foraminotomy for selected cases of radiculopathy due to foraminal stenosis, which can decompress the nerve root without fusion in some scenarios
• •Laminoplasty for selected cases of multilevel cervical myelopathy, which can decompress the spinal cord while preserving more motion than multilevel fusion in some patients
• •Observation with periodic reassessment when symptoms are mild, stable, or improving and neurologic deficits are not progressive

Sources

• AAOS OrthoInfo - Cervical Spondylosis (Arthritis of the Neck)
• AAOS OrthoInfo - Spinal Fusion
• MedlinePlus (NIH) - Spinal Fusion
• Cleveland Clinic - ACDF (Anterior Cervical Discectomy and Fusion)