22600 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment

Name of the Procedure:

Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment. Commonly referred to as posterior cervical fusion.

Summary

Posterior cervical fusion is a surgical procedure performed to stabilize the cervical spine below the C2 vertebra. It involves fusing one or more of the cervical vertebrae together using bone grafts and other surgical hardware.

Purpose

The procedure is designed to address instability, misalignment, or damage in the cervical spine. It aims to relieve pain, prevent further degeneration, and improve the structural integrity of the spine.

Indications

• Chronic neck pain not relieved by conservative treatments
• Cervical spine instability due to trauma, degenerative disc disease, or tumors
• Cervical spondylotic myelopathy
• Certain congenital spinal deformities

Preparation

• Patients may need to fast for 8-12 hours before the procedure.
• Adjustments to medications may be necessary, including blood thinners.
• Preoperative imaging tests such as X-rays, CT scans, or MRI may be required.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A small incision is made at the back of the neck.
3. Exposure: Muscles and tissues are gently moved aside to access the spine.
4. Preparation: The surgeon cleanses the bone surfaces to prepare for fusion.
5. Bone Graft: Bone grafts (autograft, allograft, or synthetic) are placed between the vertebrae.
6. Fixation: Metal plates, screws, or rods are used to hold the bones together while fusion occurs.
7. Closure: The incision is closed with sutures or staples.

Duration

The procedure typically takes 2-4 hours, depending on the complexity and the patient's condition.

Setting

It is usually performed in a hospital operating room.

Personnel

• Orthopedic or neurosurgeon
• Surgical assistants
• Anesthesiologist
• Operating room nurses

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Non-union (failure of bones to fuse)
• Instrumentation failure (e.g., loosening or breakage of screws/plates)
• Adjacent segment disease (degeneration of adjacent spinal segments)

Benefits

• Reduced neck pain
• Improved spinal stability
• Prevention of further spinal damage
• Enhanced quality of life, with benefits typically realized within 3-6 months post-surgery

Recovery

• Hospital stay of 1-3 days is common.
• Post-procedure pain management includes medications.
• Physical therapy may be recommended.
• Restrictions on heavy lifting, bending, and twisting for several weeks.
• Follow-up appointments to monitor fusion progress and overall recovery.

Alternatives

• Conservative treatments such as physical therapy, medications, or spinal injections.
• Anterior cervical discectomy and fusion (ACDF), which approaches the spine from the front.
• Risk and benefits vary: conservative treatments may offer symptom relief without surgery, while other surgical techniques may be recommended based on specific patient conditions.

Patient Experience

Patients will be under general anesthesia during the procedure and will not feel anything. Post-operatively, they may experience pain and discomfort at the incision site and around the neck, which will be managed with pain medication. Gradual improvement in symptoms and function is expected with adherence to recovery protocols.