Cervical arthrodesis

What is cervical arthrodesis?

Lumbar arthrodesis is a surgery performed on the cervical spine to fuse two or more vertebrae and limit movement between them. This surgery is advised to treat severe spinal pathologies or conditions that compromise the stability of the spine such as deformities, fractures, degenerative diseases or other ailments that cause instability and pain.

The cervical spine is located between the base of the skull and the thoracic spine and is composed of 7 vertebrae: C1 (), C2()… to C7. Its size is smaller than the other vertebrae and its main function, in addition to protecting the spinal cord, is to provide mobility and support to the skull.

What does cervical arthrodesis consist of?

Cervical arthrodesis consists of permanently fusing two or more vertebrae in the cervical area, stabilising them and ensuring that there is no movement between them. This is achieved by placing screws, boxes and/or plates (usually made of titanium alloys) that stabilise the spine and allow the vertebrae to fuse. Bone grafting (from the patient’s own, donor or synthetic bone) is also often used to reinforce and optimise fusion.

Cervical arthrodesis can be performed using different techniques and approaches, depending on the location of the vertebrae to be treated, the number and severity of the lesion/pathology.

The most common techniques for cervical arthrodesis are two:

• Anterior cervical arthrodesis: this technique involves a minimally invasive approach. During surgery, a 4-5 cm incision is made in the anterior lateral part of the neck, the damaged disc is removed and the spinal cord is decompressed in case of disc herniation or spinal cord compromise. If necessary, the space freed would be filled with bone graft and a screwed plate would be placed to ensure fusion of the vertebral discs.
• Posterior cervical arthrodesis: This is a slightly more aggressive approach. With a longitudinal incision (4-5 cm) made in the back of the neck, the cervical spine is approached from the back and metal fixation material (usually titanium plates and screws) is implanted in the lateral fragments of the vertebrae, while the free spaces are filled with bone graft to consolidate the vertebral fusion.

In which cases/pathologies is it indicated?

Your surgeon, an expert in cervical pathology, will assess the indication for this procedure on an individual basis according to the pathology, symptoms and characteristics of the patient. In general, cervical arthrodesis may be indicated in the following cases:

• Cervical canal stenosis is a narrowing of the spinal canal that can compress nerve roots and cause pain and weakness in the legs. If conservative treatment is not effective, cervical vertebral fusion may be considered to relieve symptoms.
• Cervical spondylolisthesis: Spondylolisthesis is the displacement of one vertebra over the adjacent one. If symptoms are severe or if the condition does not respond to conservative treatments, cervical arthrodesis may be an option to stabilise the spine and reduce pressure on the nerves.
• Spondylolysis: Spondylolysis is a fracture in a specific part of a vertebra. If adequate healing is not achieved or if there is instability in the spine due to this condition, cervical arthrodesis may be necessary to provide stability.
• Recurrent disc herniation: If a herniated disc recurs after conservative treatment or previous surgery, fusing the cervical vertebrae may be considered to stabilise the spine and relieve pain.
• Disc degeneration: Cervical arthrodesis may be recommended when there is significant wear and tear of the intervertebral discs, which can cause chronic pain and functional limitations.
• Vertebral fractures: due to trauma or cervical degenerative pathology.
• Vertebral tumours

How long does the surgery last?

Lumbar arthrodesis surgery is performed under general anaesthesia and can last between 2 and 4 hours, depending on the number of vertebrae to be fused and the complexity of the case.

What is the postoperative period like in hospital and at home?

After surgery, the patient must stay in hospital for an average of 3 to 5 days for pain control and recovery. The patient usually remains under observation in intensive care for the first 24 hours after surgery, after which he or she is transferred to the ward for post-operative rehabilitation with physiotherapists. In most cases, the patient will have to wear a cervical collar for a few days (or weeks, depending on the surgeon’s instructions) to help stabilise the spine and facilitate the fusion of the vertebrae.

What are the main risks?

The main risks associated with lumbar spinal fusion include infection, bleeding, nerve injury, chronic pain, pseudarthrosis (nonunion of the fused vertebrae), and anaesthesia-related complications.

What limitations will the patient have in the medium term?

After surgery, the patient may experience pain and stiffness in the cervical area for several weeks and should avoid intense physical activity and impact or lifting heavy objects.

The patient will have regular check-ups during the three postoperative months, during which radiological control will be carried out to check that the implants are correctly positioned and that the fusion is progressing.

It is important that the patient follows the recommendations of the surgeon and physiotherapist to ensure a successful recovery.