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The Purpose of this Information This information is being provided to you in order to prepare you to make decisions about your own health care. If you should ultimately decide that surgery is the best treatment option for you, this section will help you understand what happens during a anterior cervical fusion and will help you prepare for your role in the healing and recovery process. Read it thoroughly and answer the questions before making your final decision about your treatment options. The Health Care Team's Role The duty of your health care team is to:
The Patient's Responsibilities You are the only one who can decide to have surgery. It is important that you take ownership of this decision, recognizing the limitations your particular physical condition places on the potential success of each of the treatment options. If you choose to have surgery, your physical condition and your mental attitude will determine your body's ability to heal. You must approach your surgery with confidence, a positive attitude, and a thorough understanding of the anticipated outcome. You should have realistic goals-and work steadily to achieve those goals. The decision to have or not to have surgery includes weighing the risks and benefits involved. You will make the final decision, so ask questions about anything you do not understand. Since medical care is tailored to each person's needs and differences, not all information presented here will apply to the patient's treatment or its outcome. Seek the advice of your physician and other members of the health care team for specific information about the patient's medical condition. Table Of Contents Anatomy of the Back The spinal column, or backbone, consists of 33 bones (vertebrae) and can be divided into five segments (Fig. 1A). The uppermost 24 vertebrae are separated from one another by fibrous cartilage pads, called intervertebral discs (Fig. 1B), which provide flexibility to the spine and act as shock absorbers during activity. In the lowest part of the spine, the vertebrae are naturally fused to form the sacrum and the coccyx (tail bone).
Protruding from the back of each vertebral body is an arch of bone that forms the large, vertical opening (the spinal canal) through which runs the spinal cord and nerve bundles. A fluid-filled protective membrane, the dura, covers the contents of the spinal canal from where the cord begins at the base of the skull to where it ends (in a bundle of nerve fibers known as the cauda equina). A pair of spinal nerves branches at each vertebral level (one to the left and one to the right), providing sensation and movement to all parts of the body. Three large, bony projections, or processes, arise from the vertebra's arch - one to each side (transverse) and one straight towards the back of the body (spinous). Strong ligaments and muscles attached to the vertebra's body and processes support the spine and further protect the delicate spinal cord and nerves encased within.
Anterior Cervical Fusion What Is It? Anterior cervical fusion is an operation performed on the upper spine to relieve pressure on one or more nerve roots, or on the spinal cord. The term is derived from the words anterior (front), cervical (neck), and fusion (joining the vertebrae with a bone graft). Why is it Done? When an intervertebral disc ruptures in the cervical spine, it puts pressure on one or more nerve roots (often called nerve root compression) or on the spinal cord, causing pain and other symptoms in the neck, arms, and even legs. In this operation, the surgeon reaches the cervical spine through a small incision in the front of the neck. After the muscles of the spine are spread, the intervertebral disc is removed and is replaced with a small plug of bone, which in time will fuse (join) the vertebrae it lies between. Obtained from a bone bank, the preformed bone plug will not be rejected by your body because it is avascular (contains no blood cells). In some circumstances, or at the preference of your surgeon, the bone plug might instead be removed from your own hip through a second incision. What Happens Afterwards? Successful recovery from anterior cervical fusion requires that you approach the operation and recovery period with confidence based on a thorough understanding of the process. Your surgeon has the training and expertise to correct physical defects by performing the operation; he and the rest of the health care team will support your recovery. Your body is able to heal the involved muscle, nerve, and bone tissues. Full recovery, however, will also depend on you having a strong, positive attitude, setting small goals for improvement, and working steadily to accomplish each goal.
The Operation
Exposure and Removal of the Cervical Disc After a retractor is used to pull aside fat and muscle, the disc is exposed between the vertebrae. Part of it is removed with a forceps (Fig. 3).  Then a surgical drill is used to enlarge the disc space (Fig. 4), making it easier for the surgeon to empty the intervertebral space fully and remove any bone spurs. Afterwards, only a single ligament separates the surgical instruments from the spinal cord and nerve roots.  Placement of the Bone Graft The bone graft is placed in the disc space, where it will begin to fuse the vertebrae it lies between (Fig. 5).  Adding Stability: Fusion In fusion, your doctor joins (fuses) the vertebrae above and below the removed disk. Fusion is done with a bone graft, but occasionally metal plates are added. Metal plates add stability to the cervical spine and aid in the healing process (Fig. 6). 
Risk Certain risks must be considered with any surgery. Although every precaution will be taken to avoid complications, among the most common risks possible with surgery are: infection, excessive bleeding (hemorrhage), and an adverse reaction to anesthesia. Other risks possible with anterior cervical fusion include: stroke, injury to the recurrent laryngeal nerve, which causes hoarseness and may or may not be permanent; and injury to the involved nerve root(s) or the spinal cord, both of which can cause varying types and degrees of paralysis. Clinical experience and scientific calculation indicate that, in general, surgical risks are limited; however, surgery is a human effort. Unforeseen circumstances can complicate any surgical procedure and lead to serious or even life-threatening situations. Although such complications are rare, you should feel free to discuss the question of risk with your doctor.
Pain It is normal to have pain after the operation, especially in the incision area. This does not mean that the procedure was unsuccessful or that your recovery will be slow. Pain in the neck or arms is also not unusual, caused by inflammation of the previously compressed nerve. It will slowly lessen as the nerve heals. Medication will be given to control pain. Moist heat and frequent repositioning may also help. Numbness Numbness or tingling sensations are often the last symptoms to leave. Numbness which lingers in parts of the arm or fingers usually is no cause for worry and should gradually go away. Physical Activity You may move about in bed and rest in any comfortable position when you have recovered from anesthesia. Walking may begin within several hours. The easiest way for you to get out of bed is to raise the head of the bed as far as it will go, and then swing your legs to the floor. Avoid pulling up from a flat position with the trapeze. The doctor may order a cervical collar to be worn whenever you are up and about. Your nurse will explain its proper use and help with any activity. Gradually increase the amount of walking you do each day. Since it may at first be painful, try making short trips. Begin with a trip to the bathroom, then to the door, and later out into the corridor. Sitting and standing also require a gradual pace. If discomfort occurs, change positions frequently. Hygiene Usually you may take a shower the day after surgery. This will make you feel better and should be done with the dressing left in place to protect the incision. Your nurse will change the dressing afterwards. Nutrition Intravenous (I.V.) fluids will be ordered during the early recovery period and continued until you can tolerate regular liquids without nausea or vomiting. Your diet will then be adjusted back to normal as your appetite returns. Constipation will be treated with laxatives and a diet of whole grain cereals, fruits, and fruit juices. Emotional Changes It is normal to feel discouraged and tired for several days after surgery. These feelings may be your body's natural reaction to the cutback of extra hormones it put out to handle the stress of surgery. Although emotional let-down is not uncommon, it must not be allowed to get in the way of the positive attitude essential to your recovery and return to normal activity. Discharge from the Hospital The hospital stay for anterior cervical fusion patients usually lasts 1 or 2 days. This will be determined by your progress and by the amount of comfort and help available to you at home.
Physical Activity Daily walking is the best exercise. Try to increase your distance a little each day, setting a pace that avoids fatigue or severe pain. You may climb stairs when you feel able. Sexual relations may be resumed during the recovery period, but positions that strain the neck or cause pain should be avoided. "Listen" to your body. Discomfort is normal while you gradually return to normal activity, but pain is a signal to stop what you are doing and proceed more slowly. Working Your doctor will help determine when you can return to work and with what limitations. If a work release is required, it will be given to you during the first post-operative visit. Driving Drive a car only when you have recovered full coordination and are experiencing minimal pain. Do not drive after taking pain medication. Medication You should gradually use less pain medication while recovering at home. This can be accomplished by increasing the amount of time between taking pills, then by reducing the number taken each time. A certain amount of discomfort and pain in the neck and arm(s) can be expected until the inflammation and nerve sensitivity have subsided. Heat, exercise, massage, and short rest periods will also help relieve pain. Hygiene If the skin sutures were removed before your discharge from the hospital, it is not necessary to keep the incision covered. Unless instructed otherwise, you may take a daily shower or tub bath, which will help you feel better. Let the water run over the incision, but do not scrub or rub over it. Pat it dry. After bathing, massage lotion over the tightened neck muscles. Inflammation If you notice increased redness, swelling, or any drainage around the incision after leaving the hospital, notify your doctor. Nutrition A well balanced diet is necessary for proper healing. Include foods from each basic food group: dairy products, meats, vegetables, and fruits. Since you will be less active during recuperation, avoid rich, heavy foods and those high in calories but low in nutrients.
Healing is the body's natural process of restoring its damaged tissues to a normal or nearly normal state. Although healing may be improved by general good health, proper nutrition, rest, and physical fitness, it will occur without your having to work at it. Recovery is the process during which you work to become well. It requires a gradual but persistent effort to increase physical strengths and minimize weaknesses. You must concentrate on what is improving, rather than on what symptoms remain. This focus on progress that has been made, combined with the constant effort to improve, make up the positive attitude that will speed your return to normal daily activity.
Test your knowledge of anterior cervical fusion by answering the following questions.
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