Posterior Cervical Fusion

Posterior cervical fusion (PCF), a surgical procedure performed through the back of the neck, involves joining or fusing two or more damaged cervical vertebrae. The fusion of vertebrae is also known as arthrodesis. Metallic screws and rods will be used for stabilizing the vertebrae, this is also known as instrumentation.

PCF may be employed for the management of cervical fractures, bone dislocations, and deformities due to abnormal curvature of the cervical vertebrae, and after a laminectomy which can destabilize the spine.

Procedure

The basic steps of posterior cervical fusion include:

  • The procedure is conducted in an operating room with the patient under general anesthesia.
  • The patient lies face down, on the operation table.
  • A small incision is made over the middle of the neck, at the back.
  • The muscles and the soft tissues are then retracted to approach the spine.
  • X-ray imaging is employed to identify the affected levels.
  • Spinal instrumentation is placed.
  • The surfaces of the lamina of each vertebra to be fused are burred. This results in bleeding which aids in rapid healing of the fused bones.
  • Small strips of bone graft taken from the local area in addition to allograft (cadaver) bone are laid on top of the area to be fused.
  • Confirmatory X-rays are taken to confirm the proper placement of the bone graft and instrumentation.
  • Finally, the retracted muscles and soft tissues are placed in their normal positions and the wound is sutured.

Postoperative care

Patients may be discharged from the hospital within 1-2 days after surgery. A neck brace is recommended for a period of time. Patients are initiated on a liquid diet which is gradually changed to solid food, depending on their recovery.

Physical therapy is recommended after 4-6 weeks of the surgery. Physical therapists help patients perform their routine activities without exerting any extra stress on the neck. Rest is advised as it helps in healing of the bone graft.

Risk and complications

Every major surgery is associated with complications. Some of the complications associated with posterior cervical fusion include:

  • Complications related to anesthesia
  • Nonunion or pseudoarthrosis
  • Infection
  • Damage to the spinal nerves
  • Problem related to bone graft or instrumentation
  • Persistent pain, especially in the back of the neck