While most patients who need fusion surgery in the neck undergo anterior cervical discectomy and fusion (ACDF), some patients have posterior cervical fusion surgery instead.
The two spine surgeries are similar, but one major difference is that, in posterior cervical fusion, the spine surgeon approaches the spine from the back (posterior) of the patient’s neck instead of the front (anterior). The goal of posterior cervical fusion is to strengthen the spine by helping the spinal bones of the neck fuse together.
What is Posterior Cervical Fusion Surgery?
Posterior cervical fusion surgery is a spine surgery procedure in which a spine surgeon stabilizes one or more spinal bones in the neck by placing a bone graft or artificial bone material between them so that they may fuse or knit together. The term “posterior” indicates that the incision is made in the back of the neck (cervical region). Since it takes several weeks for the spinal bones to fuse together, the spinal bones are held together with instrumentation, i.e., screws, plates, and/or rods that hold the bones together. While true stability of the cervical spine occurs after the bones have fused, the instrumentation remains in place permanently.
How do I know if I need Posterior Cervical Fusion?
Posterior cervical fusion is generally reserved for those who have something wrong with the spinal bones of the neck as opposed to the cervical disc between them. A spine surgeon may suggest posterior cervical disc fusion to patients with a cervical:
Fracture (i.e., a broken cervical vertebra)
Infection Tumor (e.g., bone cancer or, more often, another cancer metastasizes to bone)
Instability
Deformity (e.g., cervical kyphosis).
You probably will not know you need posterior cervical fusion until a doctor tells you; however, people with neck trauma, metastatic cancer, or those with large deviations in the curve of the neck are more likely to require posterior cervical fusion surgery than others.
How successful is Posterior Cervical Fusion surgery?
Posterior cervical fusion surgery is successful in the vast majority of patients with spinal fractures, tumor, infections or other conditions that make the cervical spine unstable. More than three-quarters of patients enjoy good or excellent results, with overall success rates as high as 95%. The spine surgery usually resolves most neck pain in these individuals, and after posterior cervical fusion recovery, the neck is stable.
Are There Any Complications With Posterior Cervical Fusion?
Of course, all surgeries carry a certain degree of risk for infection, bleeding, or difficulties with anesthesia, and posterior cervical fusion is no different. Specific posterior cervical fusion complications include continued neck instability and pain, perhaps because the bones did not knit together properly (i.e., pseudoarthrosis). Since the spine surgeon is operating near the spinal cord and nerve roots, posterior cervical fusion complications also include nerve injury, numbness, or weakness. Be sure to ask your spine surgeon about other potential posterior cervical fusion complications prior to surgery.
What Does Recovery Look Like After Posterior Cervical Disc Fusion?
Prepare to stay in the hospital for three or four days after posterior cervical disc fusion surgery. Most spine surgeons require you to wear a neck brace during recovery. A neck brace helps you keep your head and neck in the proper position so that the spinal bones can fuse. Your activity will be limited for several weeks after surgery, and you will be given prescription medications to control your pain. Remember to keep the surgical wound clean and dry and to change the dressing once a day (or if it happens to become wet or soiled). You may shower the day after posterior cervical disc fusion surgery, but do not let water reach the incision (ask your provider about water-resistant dressing coverings).
You will have a follow-up appointment with your spine surgeon about two weeks after surgery. If you are healing well, you may be able to increase your activity level (e.g., meal preparation, desk work) with your surgeon’s permission. Remember that you may not be able to drive or perform physical work for four to six weeks after posterior cervical disc fusion, so it is best to arrange alternatives before the procedure. Your spine surgeon will confirm that your spinal bones have fused, usually by examining new X-ray images of the neck taken at about week six of recovery. If the bones are fusing well, you will likely be able to return to most normal activities.
Do You Need Physical Therapy After Posterior Cervical Fusion?
Yes, all patients will undergo physical therapy after posterior cervical fusion. A physical therapist and an occupational therapist will meet with you soon after posterior cervical fusion surgery to show you how to protect your healing neck and how to safely move about early in recovery, e.g., no twisting, no neck bending, no heavy lifting, etc. A physical therapist can also provide ways to minimize and control discomfort during posterior cervical fusion recovery. Most patients choose to continue physical therapy after posterior cervical fusion to help build strength and stamina. Patients may continue occupational therapy after posterior cervical fusion to help them safely perform routine, self-care tasks as they recover from the procedure.
Can You Get a Posterior Cervical Fusion Scar?
Yes, all patients will have a permanent mark where the incision was made in the back of the neck. In most cases, the posterior cervical fusion scar will hardly be noticeable—just a thin line that is three to five inches long—but in some it may be more apparent. The more spinal levels that need to be treated (e.g., a 5-level posterior cervical fusion), the longer the incision and the longer the potential scar.
Scheduling an Appointment With an Posterior Cervical Fusion Specialist
(What You Need, Where to Go, How to Prepare)
Choose a board-certified spine surgeon.
Every posterior cervical fusion specialist will either be a neurosurgeon or an orthopedic surgeon and will be board-certified in spine surgery. Other providers will not have the skills and experience to expertly perform posterior cervical fusion surgery.
Help your spine surgeon expertly review your case.
Your posterior cervical fusion specialist will need to obtain or review any imaging you have had on your neck including X-rays, CT scans, and MRIs. If you can, bring these imaging studies with you to the evaluation. Most radiology departments can put the studies on a CD-ROM, USB drive, or even send the images via the internet for your appointment.
Get your questions answered.
Ask your spine surgeon about your specific chances of having a successful procedure, what risks are involved, and what other options you may have. For example, is an anterior cervical fusion an option in your case? Ask what instrumentation will be needed, such as plates, rods, screws, or a cage. Indeed, make sure all of your questions have been answered to your satisfaction.
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