Posterior Cervical Fusion

A posterior cervical fusion is a surgical procedure that relieves pressure on nerve roots and/or the spinal cord by a herniated disc or bone spurs in the neck as well as stabilizing your cervical spine with screws and rods.

A posterior cervical fusion is a surgical procedure used to stabilized the cervical spine and relieve pressure on the spinal cord. During the surgery, the surgeon makes an incision in the back of your neck to access the spine. They then remove bone to relieve pressure on the spinal cord. They then use screws and rods to stabilize your spine and use bone grafts or synthetic materials to fuse the vertebrae together. The aim of the procedure is to stabilize the spine, alleviate pain and improve function.

If a posterior cervical fusion has been recommended, you likely have a herniated disc and/or bone spurs causing compression on the spinal cord in multiple levels of your neck, which can cause:

• Pain in the neck and/or arms
• Numbness or weakness in the arms, forearms, or fingers
• Lack of coordination

A posterior cervical fusion is typically recommended only after non-surgical treatment methods fail. Your surgeon will take a number of factors into consideration - including the condition being treated, your age, health, lifestyle, and activity level - to create an individualized treatment plan for you. 

Please discuss this treatment option thoroughly with your spine surgeon.

Here is a step-by-step overview of how a laminoplasty is performed:

1. Preparation: You will be given anesthesia to keep you asleep and pain-free during the surgery.
2. Incision: The surgeon makes an incision in the back of your neck to access the spine.
3. Muscle Retraction: The muscles in the back will be gently retracted to access the spine.
4. Laminectomy: The surgeon carefully removes part of the bone called the lamina to make more room for the spinal cord.
5. Stabilization: The surgeon implants screws in the bones of your spine and connects them with rods to stabilize your spine.
6. Closing the Incision: The surgeon closes the incision with stitches under the skin, sometimes staples or stiches are used on the skin, and applies a bandage.
7. Recovery: You will be monitored in the recovery room. You will stay in the hospital for a short period. You will receive instruction for managing pain, wound care, and physical activity during your recovery.

The goal of the procedure is to relieve pain and restore function by expanding the space for your spinal cord and stabilizing the spine.

Your surgeon will have a specific recovery plan to help you return to your normal activity level as soon as possible after your surgery. You will stay in the hospital for a short period of time, usually 1-2 days. You will typically be up and walking the day of your surgery or the day after. You can return to work in 3-6 weeks, depending on how well your body is healing and the type of work/activity you do.

Work closely with your spine surgeon to determine the appropriate recovery for you.

While ACDF is generally safe, there are potential risks and complications to be aware of:

1. Infection: There is a risk of infection at the incision site or in the deeper tissues.
2. Bleeding: Some bleeding can occur during or after the surgery, though it is typically controlled.
3. Nerve Injury: There is a small risk of damage to the nerves near the spine, which might cause weakness, numbness, or pain.
4. Spinal Cord Injury: Although rare, there is a risk of injury to the spinal cord, which could lead to serious complications.
5. Nonunion or Malunion: Sometimes, the vertebrae may not fuse as expected, or the fusion might not occur correctly, leading to persistent pain or instability.
6. Hardware Problems: The screws and rods can become loose or fail, which could lead to the need for additional surgery.
7. Persistent Pain: There is a possibility that you might still have some pain or discomfort even after the procedure.
8. Problems with anesthesia: Your anesthesiologist will talk to you about these potential risks.

It's important to discuss these risks with your surgeon, who can provide more information based on your specific situation and help you understand how they plan to minimize these risks.

Your incision is closed with sutures (also called "stitches") underneath your skin. These are absorbed by your body over time. The outside of your skin is closed with a skin glue or staples/stitches. It is normal to have a small amount of brown or reddish oozing from your incision for a few days.

If you have Skin Glue:  

• Skin glue appears white, dry, and crumbly. Sometimes it is brown and crumbly.  
• The skin glue will gently break down and crumble off your skin, leaving it healed underneath.  
• Cover the dressing with gauze and tape for 1 week after surgery 
• After 1 week, you may remove the dressing and leave the incision uncovered.  
• Avoid getting skin glue wet for 7 days (unless instructed otherwise by your surgeon).

**Do not scrub off the skin glue 

If you have Staples or Sutures in your Incision:  

• Depending on your surgery type and how quickly your wounds heal, staples/sutures may be removed between 10-21 days after the date of surgery.   
• Keep the incision dry while staples/sutures are in place and 24 hours after they are taken out. 
• Do not use cream, lotions, or ointments (including antibiotic ointment or cream) on the incision while sutures or staples are in. 
• Incisions can be cleaned with normal saline.  
• Your primary care provider or home physical therapist/nurse may remove the sutures/staples if appropriate, or you may have them removed at our clinic.  
• Steri-strips or butterfly strips may be placed after the removal of your staples or sutures. These should remain on until they fall off by themselves. 

• It is normal to have a sore throat after endotracheal intubation, and this will improve over the week after surgery.
• It is normal to have pain in your neck or between your shoulder blades. The muscles had to be moved to access your spine to do the surgery. This will improve over the next few weeks 

• You will be given prescriptions for a pain medication.
• Use medication as directed.
• Do not drink alcohol if you are taking pain medication.
• If you feel that your pain is well tolerated, you may begin to wean yourself off of your pain medication as soon as you would like.
• If your pain requires narcotic pain medication >4 weeks after surgery, you will be referred to a pain management specialist to help wean you off these medications.
• Pain medication can cause constipation. Take the stool softener daily and use the laxative as needed. If you still have constipation after using these medicines, you may use an over-the-counter suppository or enema.  

• NO Aspirin, Advil, Aleve, Motrin, Naprosyn, Ibuprofen, Naproxen, Mobic, Meloxicam, Celebrex, or any other anti-inflammatory medication.  These medicines may impair fusion.  We discourage use of these medications for the first 3-6 months after a fusion surgery.
• NO blood thinners such as Aspirin, Coumadin, Warfarin, Xarelto, Plavix, etc.  for 5-7 days after your surgery.  We will tell you when you may resume your blood thinners.  

• When you are at home, walk between 30-60 minutes a day, but not all at the same time. Divide your walks into smaller intervals of 10-15 minutes at a time.
• Try to not sit for more than 30 minutes at a time.  Sitting for long periods of time can cause more discomfort.
• Use your common sense, if your body says that it is tired, listen to it.

• Activities including working above your shoulders and lifting >10 pounds are restricted during your recovery period, which is about 6 weeks.
• This means NO household chores such as vacuuming and laundry, hobbies such as golfing, and yard work/gardening.
• If you have young children or grandchildren, do NOT pick them up.  
• You may drive as long as you are not taking narcotic pain medication. 
• If you are unable to work due to these restrictions, please let us know if we need to complete any paperwork for your employer. 

• You may advance your diet to normal as you feel comfortable.

• Do not use any sort of nicotine during your recovery. This includes smoking, smokeless tobacco, vaping and nicotine patches.
• Nicotine constricts your blood vessels which carry oxygen and nutrients to your healing bone and muscles. 
• It also slows down the bone healing process and may possibly lead to failure and necessitate additional surgery.
• If you would like help in cessation, please let us know.

• A follow-up visit will be scheduled about 4 weeks after your surgery.
• It is important to keep your appointments after a fusion surgery, as your surgeon typically performs x-rays over the first year after your surgery to ensure it is healing correctly.
• If you need this appointment changed, please call our office 

• Fever > 101 degrees 
• Constipation that is not relieved by stool medications 
• Redness, warmth, or significant drainage from your incision
• Shortness of breath or Chest Pain 
• Pain, swelling, or redness in your calves
• Unexplained incontinence or accidents involving your bladder or bowel, or if you are unable to urinate
• Worsening neck or arm pain
• Inability to tolerate a diet 

If you are experiencing any problems or have any questions, please contact our office at (573) 635-8000

After surgery patients should avoid bending, lifting, and twisting. It is helpful to place items you use daily on the countertops or shelves where you can easily reach them. Keep toiletry items near the sink. Place dishes on the kitchen counter.

If you live alone, it is a good idea to have a friend or family member stay with you for the first few days after surgery. You may need help with errands or getting around the house. If you require more extensive help after surgery, home health services may be provided.   

It can be difficult to prepare healthy meals the first few days you are recovering from back surgery. Prepare your meals ahead of time that you can keep in your freezer. You should also stock your refrigerator and pantry with healthy snacks.

Slip -on shoes and grabbers can be very helpful after surgery. If you are doing physical therapy exercises or walking for longer periods of time, you may want to have someone help you lace up your shoes instead of wearing slip-on shoes.  Grabbers are hand-held devices that are about 2-3 feet long and have a grabber on the end to pick up small items.  They can be purchased at department stores and pharmacies.   

Patients are encouraged to get up and walk around after surgery.  You will want to make sure to avoid any slipping hazards in your walking path. Before surgery, make sure that the areas where you will be walking are clear of tripping hazards. Cords should be secured and out of the way. Rugs should be removed or taped down. A shower mat can help avoid slipping in the shower.   

When lying on your back, a pillow placed under the knees can help to take pressure off your lower back. If you prefer to lay on your side, you can place a pillow between your knees. Reclining chairs and donut pillows can sometimes help to increase a patient’s comfort while sitting.

Taking time to prepare yourself and your home before surgery will help to ease your mind to know that everything is in place for you when you return home from surgery.