Fusion of the cervical vertebrae by posterior approach
Fusion of the cervical vertebrae is a surgical technique that allows unification of the bones in the cervical vertebrae with the spine. If performed through a posterior approach, it provides access to the spine from the back of the body.
What is fusion of the cervical vertebrae by a posterior approach?
The fusion of the cervical vertebrae by posterior approach can unite the bones of the cervical spine with or without the insertion of metal (titanium) or non-metal implants (screws, hooks, rods, plates). Since the union is solid, a bone graft is necessary, which can be taken from the iliac crest, from the spinous processes and laminae (the rear portion of the vertebrae themselves) or it can be of synthetic origin.
The procedure involves making an incision in the central area of the back and a dissection to expose the spinous processes of the vertebrae and the lamina and to drill holes in the bone in which screws that are necessary to perform arthrodesis are inserted.
Which patients can undergo the treatment?
Fusion of the cervical vertebrae is indicated in cases of trauma or deformation following a trauma, infections, tumours, cervical spondylosis, cervical degenerative deformity and stenosis.
What is required hospitalization?
The surgery is performed under general anaesthesia, with the patient intubated. In the case of unstable cervical trauma the spine must be immobilized (for example with a collar). Furthermore, it may take a bladder catheter and other tools to reduce the risk of deep vein thrombosis. After being transferred to the operating table the patient is held in position with proper tools, in order to reduce abdominal pressure and facilitate the venous return from the legs.
What are the benefits of the posterior cervical fusion?
Fusion of the cervical vertebrae by posterior approach was the preferred procedure until the 1980s, when the same procedure began to be performed through an anterior approach to treat traumatic fractures of the cervical spine. Currently the debate about what is the best approach is still open. Data in scientific literature show the effectiveness of both procedures and at the time the logical choice proceeds on the side on which the large part of the problem to be solved is located. The surgeon may, however, take in consideration other parameters, such as cervical instability.
In addition, the posterior approach offers the advantage of a reduction of the risks to the blood vessels and the viscera. The disadvantages may include major inconveniences and post-operative pain compared to those typical for cervical arthrodesis by anterior approach, the need for a lengthier hospital stay as well as the potential risks associated with the vertebral arteries and the nervous structures.
Is fusion of the cervical vertebrae by a posterior approach painful and/or dangerous?
The project is associated with the risk of nerve damage and loss of cerebrospinal fluid. Moreover, grafts can increase the risk of osteoarthritis. Discomfort and post-operative pain are common consequences.
After surgery it is recommended to monitor the functional status and neurological healing of the wound. Some doctors recommend the use of temporary external orthotics, such as collars.
Standards of preparation
The patient should be in the hospital with the results of all tests carried out prior to the procedure and follow the instructions given by a doctor regarding food and drugs routinely employed.