Stabbing, persistent neck pain can be disabling. Patients oftentimes turn to surgery in the hopes of eliminating the pain. What is a neck fusion? What are the neck fusion complications? Let’s dig in.
A neck fusion is a surgical procedure where one or more of the cervical bones (vertebrae) are fused together using hardware. The hardware may be placed either in the front (anterior) or the back of the neck (posterior). The disc between the bones is often times removed and replaced with bone or a spacer. Neck fusion rates are increasing and from 1997 to 2012 increased 114% in New York State (1).
What are the Neck Fusion Complications?
Failure of the bones to fuse which is called non-union or pseudoarthrosis. This is bad as the intended surgery has failed and now there is instability in the neck. The incidence of non-union is striking and in one study was found to be 52% (2). The treatment for non-union is terrible as it involves another surgery where the fusion is revised and oftentimes the fusion is extended up or down an additional level.
Difficulty swallowing is called dysphagia and can after neck fusion. The incidence of dysphagia within one week after surgery varies from 1 to 79% in the literature (3). Difficulty swallowing can compromise calorie, fluid intake, and healing.
The dura is the outermost membrane that covers the brain and spinal cord. This important membrane can be punctured during surgery causing a leak of spinal fluid. The incidence ranges from 1-17% (4). Severe headache is a common symptom of dural leak If left untreated may lead to infection, brain abscess and bleeding (5).
Nerves can be damaged during surgery and the incidence varies from 0.18% to 2.6% (6). Nerve injury can include exiting nerves as well as the spinal cord itself. Patients who undergo surgery for nerve pain may awaken after surgery with new-onset left arm, face or lower extremity pain.
Infection is a devastating complication and was found to occur in 16.6% of patients in a recent study. (7). Infection can involve the skin, muscle or bone. Treatment involves antibiotics, wound care and 47% of patients in a recent study required additional surgery for wound care and skin grafting.
Adjacent Segment Disease
Adjacent segment disease (ASD) is a common complication of neck fusion with an incidence of 21% (8). The neck discs are designed to absorb the forces of daily living. Fusing one or more discs together results in additional forces being placed on the disc and facet joints above and below the fusion. This additional pressure results in wear and tear and degeneration often times requiring additional surgery. See our video below:
No Reduction in Pain
Inadequate symptom relief after the surgery. Despite surgery and rehabilitation, some patients do not get better after surgery. In a recent study 1 year after neck fusion only 39% of patients were able to return to work. (9)
Alterations in Spinal Curve
Changes in the spinal curve. In a recent study, 48 patients who had undergone neck fusion had whole spine X-rays at 1,3,6, and 12 months after surgery. They noted that changes in the neck curve from surgery impacted the angles of the tailbone and pelvis (10).
Is There a Non-Surgical Option to Treat Neck Pain?
The spine is made of building blocks called vertebrae. The shocker absorbers between the vertebra are called discs. A joint in the back of the spine is called the facet joint. Each of these structures can be a source of pain and needs to be evaluated thoroughly.
To better understand the spine, how it works and what can cause pain and injury please click on the video below.
At the Centeno Schultz Clinic platelet and stem cells are precisely injected into the neck using x-ray and ultrasound guidance. The injections are challenging and can not be performed by your surgeon, chiropractor or physician assistant. To watch a Centeno-Schulz clinic injection click on the video below.
Neck fusion is a surgical procedure where two or more neck bones are fused together. The procedure is associated with significant complications which include non-union, dysphagia, dural leak, nerve damage, infection, adjacent segment disease and most disturbing, inadequate pain relief. Before you consider neck fusion know that there are non surgical options which include precise injections of platelets and stem cells.
- Salzmann SN, Derman PB, Lampe LP, et al. Cervical Spinal Fusion: 16-Year Trends in Epidemiology, Indications, and In-Hospital Outcomes by Surgical Approach. 2018;113:e280-e295.DOI: 10.1016/j.wneu.2018.02.004
- Anderson KK, Arnold PM. Oropharyngeal Dysphagia after anterior cervical spine surgery: a review. . 2013;3(4):273-86.doi: 10.1055/s-0033-1354253
- Tosun B, Ilbay K, Kim MS, Selek O. Management of Persistent Cerebrospinal Fluid Leakage Following Thoraco-lumbar Surgery. Asian Spine J. 2012;6(3):157-62. doi: 10.4184/asj.2012.6.3.157
- Fang Z, Tian R, Jia YT, Xu TT, Liu Y. Treatment of cerebrospinal fluid leak after spine surgery. Chin J Traumatol. 2017;20(2):81-3.doi: 10.1016/j.cjtee.2016.12.002
- Cheung JP, Luk KD. Complications of Anterior and Posterior Cervical Spine Surgery. Asian Spine J. 2016;10(2):385-400.doi: 10.4184/asj.2016.10.2.385
- Barnes M, Liew S. The incidence of infection after posterior cervical spine surgery: a 10 year review. Global Spine J. 2012;2(1):3-6.doi: 10.1055/s-0032-1307252
- Buttermann GR. Anterior Cervical Discectomy and Fusion Outcomes over 10 Years: A Prospective Study. Spine. 2018;43(3):207-14.DOI: 10.1097/BRS.0000000000002273
- Faour M, Anderson JT, Haas AR, et al. Return to Work Rates After Single-level Cervical Fusion for Degenerative Disc Disease Compared With Fusion for Radiculopathy in a Workers’ Compensation Setting. Spine. 2016;41(14):1160-6.DOI: 10.1097/BRS.0000000000001444
- Kim JH, Park JY, Yi S, et al. Anterior Cervical Discectomy and Fusion Alters Whole-Spine Sagittal Alignment. Yonsei Med J. 2015;56(4):1060-70.DOI: 10.3349/ymj.2015.56.4.1060