This operation is often performed together with a discectomy with a thorough decompression.

Who needs it?

Patients with severe neck pain, which is secondary to instability of the spine, or who are suffering from severely painful discs AND who have been treated with other non-surgical techniques and have failed to improve, may be candidates for fusion surgery. In addition, the more common reason is for patients with severe pain radiating to the upper extremity (radiculopathy).

Pre operative advice

48 hours before surgery, take some gentle laxatives (lactulose, senna) to ensure you have your bowels opened on the day of surgery.

On the day of your surgery it is important to remain Nil By Mouth (NPO). Do not eat past midnight the night before your operation. However you may continue to drink water up to two hours before admission, where you will be advised further.

It is not necessary to bring your medications with you, as these are supplied from Pharmacy at The Hospital (you can use your medications when you return home). However, if you take a number of medications, please bring a list of names and doses so they can be appropriately supplied by the pharmacy department.

Please bring your scans with you to The Hospital.

How is it done?

The cervical spine may be approached from the front, when the fusion is combined with a discectomy and decompression. An anterior fusion involves removal of one or more discs, insertion of bone graft or a suitable spacer into the disc space, to maintain the disc height and allow bone to grow across the gap and, usually, the application of a small plate to the front of the spine to hold it together until the bone has healed.

A posterior fusion requires retraction of the large muscles at the back of the neck, is often quite painful post-operatively, and insertion of screws into the bones, which are joined together with a plate or rod system. Bone graft is also positioned alongside and it is this which ultimately fused one vertebra to another.

Post operative care

You will wake up in post-anesthesia care unit (PACU), where you will spend a short time recovering from the anaesthetic.

You will then be transferred back to the ward.

You may be given a Patient Controlled Analgesia pump (PCA). You will be given a button to press for a dose of pain relief from the pump, and there is a lockout period so it is not possible to have too much. This is an effective way of controlling your pain, especially while you can’t eat and drink.

On day 1 post operatively, you will be seen by the physical therapy team on the ward. They will start teaching you how to safely get out of bed, and will help you to start walking again. You may feel lightheaded or dizzy the first few times you get up — this is normal, and will wear off. The therapist may also fit you with a collar to support your neck. You will have to wear this for several weeks. There may be opportunity to use the hydrotherapy pool during your inpatient stay.

Your wounds will be managed by the nursing staff; they will be dressed as needed. They will also provide you with the appropriate information for discharge.

When you go home

You will be given a cervical collar to wear for several weeks, to prevent excessive movement and to remind the patient that they are healing.

For the first 6-8 weeks, it is important that you take things easy. Do not start lifting or exercising during this period. You may walk about as pain allows, whilst wearing the collar, but not too vigorously. Several short walks, rather than one long walk.

You will not be permitted to drive for 6 weeks, until you feel fit to perform the emergency stop. However you may be a passenger during this time, as long as you take regular rest periods to adjust your position.

Flying is not a problem, but airports are. Avoid carrying luggage, especially off the carrousel. Try to avoid sitting for too long — get up and exercise when it is safe to do safe. Please also check with your airline before flying.

With regards to working, please discuss this with your surgeon, as this varies depending on the work you do. Patients may return to work in a sedentary occupation when they feel comfortable. Those in manual jobs may need to be off work for longer, until the fusion is solid, as demonstrated by the x-rays.

The Nursing staff on the ward will have given you some information on wound care prior to discharge. If you have any concerns regarding you wound, please do not hesitate to contact us. The stitches are dissolvable and will not need removing. In general, all dressings can be changed after 72 hours, with a new dressing applied every day thereafter if the incision is draining. However, if no drainage is present, the dressing may be discontinued. Moreover, you may shower and wet the incision after 72 hours, but bathing or soaking the incision is not recommended for 2 weeks.

Pain killers can be constipating so we encourage you to eat food that will help to keep your bowels working well. Drink plenty of water

Rehabilitation

From 6 weeks post op, assuming the x-ray appearances are satisfactory, you will start physiotherapy. These exercises are very gentle initially and increase over 6 weeks, so that by 12 weeks post-op you will be in the gym, swimming or cycling regularly.

Patients are seen at six weeks post-operatively and then at 3, 6 and 12 months with x-rays taken at each visit to determine the stage of healing. If metal screws are used these may be removed 1 — 2 years later, but this is usually not required.

An example of a patient’s Preoperative and Post operative Xrays who had surgery by Dr Bhatti.