Understanding Trapezius Muscle Pain After Cervical Fusion Surgery

Get Help With Muscle Pain After Cervical Fusion Surgery

Your neck pain is debilitating. Medications, therapy, and other conservative treatments have failed to provide any relief. Your doctor is recommending surgery. Let us dig into what cervical fusion surgery is and its different types, conditions that can be treated with the surgery, and its associated risks.

Also, we discuss the nine major causes of muscle pain after cervical fusion surgery and the alternative treatment options.

A Brief Overview of Cervical Fusion Surgery

Cervical fusion surgery is a medical procedure designed to address issues related to the cervical spine, which is the portion of the spine located in the neck. This surgical intervention aims to alleviate pain, instability, or neurological symptoms caused by conditions such as degenerative disc disease, herniated discs, spinal stenosis, or traumatic injuries.

Cervical fusion involves joining two or more vertebrae in the neck using bone grafts, screws, and plates to promote the fusion of adjacent bones, stabilizing the affected area and potentially reducing pain, and restoring function.

What Is Cervical Fusion Surgery?

Cervical fusion is a major surgery that involves joining one or more of the spinal bones together using screws, bolts, and plates.(1) The hardware may be placed in the cervical spine’s front (anterior) or back (posterior). The disc between the spinal bones is often removed and replaced with a bone graft or a spacer.

The neck is composed of seven boney building blocks that are numbered from 1-7. The letter C is associated with the numbers to designate the cervical spine. Hence the bones in the neck are C1 through C7. Sandwiched between neck bones are important shock absorbers called discs.

A cervical fusion surgery removes this important shock absorber and joins the adjacent bones together with hardware. To learn more about this, check out our blog post, “Life After Three Level Cervical Fusion Surgery.”

Different Types of Cervical Fusion Surgery

There are many different types of cervical fusion surgeries. They can be easily categorized by surgical approach and the number of levels treated. The surgical approach identifies the method utilized by the surgeon to access the discs. There are two principal approaches:

Anterior
The surgeon removes the discs through an incision in the front of the neck. Removal of the disc is called a discectomy. The screws and plates are placed at the front of the neck. This type of surgery is commonly referred to as ACDF (anterior cervical discectomy and fusion).
Posterior
During a posterior fusion, the surgeon removes the discs through an incision in the back of the neck. The screws and plates are then placed in the back of the neck. This type of surgery is commonly referred to as a PCF (posterior cervical fusion). This approach requires the removal of important spinal bones in addition to the disc called the lamina. The lamina provides critical support and protection of the spinal cord.

Cervical fusion surgery may involve one or more affected discs. For example, a three-level fusion is a major surgery where three cervical discs are removed, and hardware is placed to stabilize the neck.

Cervical fusion is a popular surgery; the posterior cervical fusion rate in the US increased 2.7-fold from 2001 to 2013.(2)

Conditions That Can Be Treated with Neck Fusion Surgery

The following are some of the common medical conditions that can be treated with neck fusion surgery:

Degenerative disc disease (DDD): This condition involves the gradual breakdown of the intervertebral discs in the neck, leading to pain, stiffness, and reduced mobility. Neck fusion surgery can be performed to stabilize the affected discs and alleviate associated symptoms.
Herniated discs: When the soft inner core of a disc in the cervical spine protrudes through the outer layer, it can result in nerve compression and pain. Neck fusion surgery may be recommended to alleviate pressure on the nerves and restore spinal stability.
Spinal stenosis: This occurs when the canal housing the spine narrows. This puts pressure on the spinal cord and nerves. Neck fusion surgery can address spinal stenosis by creating space within the canal. This can stabilize the affected vertebrae.
Spondylolisthesis: This condition involves the displacement of one vertebra over another, potentially causing instability and nerve compression. Neck fusion surgery is a common approach to realign and stabilize the vertebrae.
Fractures and traumatic injuries: Severe fractures or traumatic injuries to the cervical spine may necessitate neck fusion surgery to restore stability, align the spine, and prevent further damage.
Tumors: In some cases, tumors in the cervical spine may require surgical intervention, including neck fusion, to remove the tumor and stabilize the spine.
Instability: Conditions that result in excessive movement between vertebrae, such as ligamentous laxity or post-traumatic instability, can be addressed through neck fusion surgery to restore stability and prevent abnormal motion.

Risks Associated with Cervical Fusion

All surgery is associated with risks. The most common immediate risks associated with cervical fusion surgery include:

Infection: Infection is a devastating complication and was found to occur in 16.6% of patients in a recent study.(3) Infection may involve the skin or deeper structures such as the bone. The latter is a severe complication often requiring additional surgery.
Excessive bleeding: The neck is rich in blood vessels that can be cut or injured, resulting in significant bleeding. Bleeding can occur while in surgery or hours to days thereafter, which may require additional surgery.
Difficulty swallowing: Difficulty swallowing or dysphagia can occur after neck fusion. The incidence of dysphagia after surgery in one study was 12.7%.(4) It can compromise calorie and fluid intake, and healing.
Reaction to anesthesia: Cervical fusion is a major surgery that requires a general anesthetic. The risks of general anesthesia include nausea, vomiting, allergic reaction to anesthetic medicines, respiratory depression, and reduced blood pressure and heart rate. General anesthesia is associated with an increased risk of dementia.(5)
Spinal fluid leak (CSF): The dura is the outermost membrane that covers the brain and spinal cord. This important membrane can be punctured during surgery, causing a spinal fluid leak. The incidence ranges from 1-17%.(6) Severe headache is a common symptom of dural leak. If left untreated, a spinal fluid leak can lead to infection, brain abscess, and bleeding.(7)

What Muscles Are Commonly Affected by Pain?

Pain after cervical fusion surgery and its impact on muscles includes the following:

Trapezius: The trapezius muscle spans the upper back and neck. Patients may experience pain and discomfort in the trapezius muscle, especially if there was manipulation or retraction of the muscle during surgery.

Shoulders: Shoulder pain may arise due to the proximity of the surgical site to the shoulder muscles. Discomfort in the shoulders can be a result of altered posture or muscle tension during the recovery period.

Upper back: Muscles in the upper back may be affected, including the rhomboids and latissimus dorsi. Surgery-related changes in posture, muscle manipulation, or altered movement patterns can contribute to upper back pain.

Hip: Pain may occur at the hip site where the bone graft was harvested. Discomfort in the hip region is common when a bone graft is taken, and patients may experience pain, stiffness, or difficulty with hip movement.

Arms: Radiating sensations can extend down the arms due to nerve involvement. Tingling or numbness in the arms may occur if there is nerve irritation or compression during or after surgery.

Neck: Pain at the neck incision site is typical and can result from tissue trauma, inflammation, or the healing process.
Chest: Pain in the chest may be experienced due to the proximity of the surgical site. Surgical manipulation and changes in breathing patterns during recovery can contribute to chest discomfort.

Types of Muscle Pain from a Cervical Fusion Surgery

Cervical fusion surgery can give rise to various types of muscle pain, impacting different areas of the neck and surrounding regions. Here are some common types of muscle pain associated with cervical fusion surgery:

Persistent neck pain: Some patients may continue to experience neck pain at a similar level to what they had before the surgery. Surgical trauma, inflammation, or incomplete resolution of pre-existing conditions can contribute to persistent neck pain.
Muscle tightness: A sensation of tightness or stiffness in the neck muscles may occur. This is often due to surgical manipulation, altered biomechanics, or protective muscle guarding in response to the surgical procedure.
Cramps and spasms: Involuntary contractions or spasms in the neck muscles are another type of pain post-surgery. Surgical trauma, changes in muscle function, or nerve irritation can lead to cramps and spasms during the recovery phase.
Intense neck pain: Sharp, severe, or intense pain in the neck region can occur after surgery. This is due to surgical trauma, nerve compression, or heightened sensitivity of the nervous system during the healing process.
Numbness and tingling: Sensations of numbness and tingling radiating from the neck to the shoulders, arms, hands, and fingers can also occur. These sensations are due to nerve irritation or compression during surgery, or inflammation affecting nerve function.

Trapezius Pain After Cervical Fusion

Trapezius pain is a common occurrence after cervical fusion surgery. There is discomfort, soreness, or pain specifically localized to the trapezius muscle. Surgical manipulation or retraction of the trapezius during the procedure leads to muscle strain or irritation.

Can You Prevent Pain After Cervical Fusion?

While it may be challenging to completely prevent all forms of pain after cervical fusion surgery, there are strategies and interventions aimed at effectively managing and minimizing discomfort during the recovery process. Here are some key approaches to pain management after cervical fusion:

Medication management: Patients are often prescribed pain medications, anti-inflammatories, and muscle relaxants to manage postoperative pain and reduce inflammation. Adhering to the prescribed dosage and schedule is crucial for effective pain control.
Physical therapy: Early mobilization and engaging in gentle, prescribed exercises and physical therapy help prevent muscle stiffness and promote proper healing. Physical therapists can guide patients through appropriate exercises tailored to their specific condition.
Posture awareness: Educating patients on proper posture and body mechanics is essential. Maintaining good posture and avoiding activities that strain the neck can help prevent unnecessary stress on the healing tissues.
Activity modification: Patients should follow their healthcare provider’s guidance on gradually resuming daily activities. Avoiding excessive strain and gradually increasing activity levels can contribute to a smoother recovery.
Use of supportive devices: In some cases, healthcare providers may recommend the use of neck collars or braces to provide additional support during the early stages of recovery.
Patient education: Educating patients about what to expect during the recovery process helps manage expectations and reduce anxiety. Knowing that some level of discomfort is normal can be reassuring.
Pain diary and communication: Keeping a pain diary to track the intensity and nature of pain can assist healthcare providers in adjusting pain management strategies. Open communication about pain levels and concerns is crucial for timely intervention.
Follow-up care: Adhering to scheduled follow-up appointments with healthcare providers allows for ongoing assessment of the recovery process. Any concerns or changes in symptoms can be addressed promptly.
Psychosocial support: Recognizing the emotional impact of surgery and providing psychosocial support can contribute to a more positive recovery experience. Stress management techniques and support from family and friends are beneficial.

Common Causes of Muscle Pain After Cervical Fusion Surgery

Cervical fusion is a major surgery associated with risks that cause muscle pain. The most common causes of this muscle pain include:

Neck instability: While the goal of cervical fusion is to stabilize the spine, there is a potential risk of inadequate stabilization or unintended consequences leading to instability and muscle pain.
Incorrect diagnosis: Surgery based on an incorrect diagnosis may not address the actual cause of symptoms, leading to persistent muscle pain.
Nerve injury: Injury to nerves during surgery can result in neurological deficits such as weakness, numbness, or muscle pain.
Failed fusion: Insufficient bone growth between fused vertebrae can lead to pseudarthrosis and potential ongoing muscle pain.
Adjacent segment disease: Increased stress on adjacent vertebrae due to fusion may lead to accelerated wear and tear, potentially causing pain in adjacent segments.
Damaged or stretched neck muscles: Manipulation or retraction of muscles during surgery may lead to muscle damage, contributing to postoperative pain and stiffness.
Shoulder injury: Surgical positioning or manipulation can contribute to shoulder discomfort or injury.
Incorrect screw placement: Misplacement of screws or hardware may lead to inadequate stabilization or unintended pain.
Poor posture: Improper posture during the recovery phase may contribute to ongoing discomfort and muscle pain.

What You Should Do if Pain Persists

Persistent muscle pain after cervical fusion surgery requires careful attention and appropriate management. If you find that muscle pain persists, consider the following steps:

First Aid Treatments

You can use first aid treatments that involve the following:

Assess and observe: Assess the nature and intensity of the pain. Observe for any signs of inflammation, changes in mobility, or other concerning symptoms.
Self-care measures: Initiate self-care measures, including over-the-counter (OTC) pain medications (as directed), rest, and gentle stretching. Avoid activities that exacerbate the pain.

Consult Your Doctor

If the pain persists for an extended period or worsens, consult your doctor. Your doctor will conduct a thorough evaluation, which may include a physical examination, imaging studies (X-rays, MRI), and a review of your medical history.

Get Proper Treatment

If the pain persists, other treatment options include:

Physical therapy: You can do targeted exercises and physical therapy to improve muscle strength, flexibility, and overall neck function.
Medication adjustment: Your doctor may adjust your pain medications or recommend alternative medications to better manage symptoms.
Injections: Epidural steroid injections or nerve blocks may be considered to reduce inflammation and provide targeted pain relief.
Revision surgery: In cases of failed fusion or persistent issues, revision surgery may be recommended to address underlying concerns.
Electrotherapy: Modalities such as transcutaneous electrical nerve stimulation (TENS) may be employed to manage pain.
Mind-body techniques: Techniques such as relaxation exercises, meditation, or biofeedback may help manage pain and improve overall well-being.

How to Avoid the Complications or Even the Surgery

The best way to avoid the significant risks, and complications of fusion surgery is to avoid having cervical fusion in the first place. Is there any alternative? Absolutely!

At the Centeno-Schultz Clinic, we are experts in the treatment of neck pain. We are the leaders in the field of regenerative medicine and interventional orthopedics. We were the first clinic in the world to inject stem cells into the lumbar disc. We have published extensively in recognized, peer-reviewed journals.

Our list of publications is available here. How patients fare after a procedure is important. For that reason, we track patient outcomes over multiple time points. To see our outcomes, please click here.

Treatment options include specialized PRP, bone marrow stem cells, and adipose grafts. At the Centeno-Schultz Clinic, all injections are performed under X-ray or ultrasound guidance. This ensures that PRP and/or stem cells are accurately placed into the damaged areas.

Blind injections are not acceptable and are below our standard of care. With blind injections, there is no assurance that the PRP or cells are injected into the targeted tissue. The injections are challenging and cannot be performed by your surgeon, chiropractor, or physician assistant.

Make Your Treatment Less Painful but More Effective

Optimizing the effectiveness of post-cervical fusion surgery treatment while minimizing discomfort is paramount for a successful recovery. As patients navigate the challenges of muscle pain, exploring advanced and patient-centric approaches can make a significant difference.

In the realm of regenerative medicine, the Centeno-Schultz Clinic stands out for its innovative techniques and commitment to patient well-being. Specializing in cutting-edge treatments such as platelet-rich plasma (PRP) and stem cell therapies, the clinic aims to enhance healing and minimize pain using the body’s own regenerative capabilities.

These approaches, tailored to individual needs, have shown promise in managing post-cervical fusion muscle pain with reduced invasiveness.

Worried about your muscle pain and chances of undergoing a second surgery? Get in touch with us and we will help you out.

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