July 8, 2024

Posterior Cervical Fusion at Strenge Spine Center, Paducah, KY

Posterior cervical fusion is a surgical procedure performed by Dr. K. Brandon Strenge at Strenge Spine Center in Paducah, KY, to address various spinal health issues affecting the cervical (neck) region of the spine. This surgery treats conditions that cause spinal cord compression, instability, or deformities in the cervical spine. Through posterior cervical fusion, Dr. Strenge decompresses the spinal cord and nerve roots by removing bone spurs, portions of the lamina, or other compressive structures. Additionally, the fusion procedure stabilizes the cervical spine by fusing two or more vertebrae together using bone grafts and instrumentation (screws, rods, plates). This prevents excessive motion, restores proper spinal alignment, and protects the spinal cord from further injury or deterioration.

Dr. Strenge’s expertise lies in utilizing advanced surgical techniques, including minimally invasive approaches, intraoperative imaging/navigation, and precision instrumentation placement. As a fellowship-trained orthopedic spine surgeon and principal investigator in clinical trials, Dr. Strenge stays at the forefront of spinal healthcare innovation. His commitment to using the latest techniques and technologies ensures that patients at Strenge Spine Center receive comprehensive, cutting-edge treatment tailored to their individual needs.

Understanding Posterior Cervical Fusion

Posterior cervical fusion with instrumentation provides immediate and rigid stabilization of the cervical spine, which is crucial in cases of instability, trauma, or deformities that compromise the spine’s structural integrity. It protects the spinal cord and nerve roots from further compression or injury caused by excessive motion or deformity progression. Instrumentation allows for earlier mobilization and rehabilitation compared to non-instrumented fusion techniques.

Importantly, particular attention is given to addressing instability at the C1-C2 level (atlantoaxial joint), as this region is critical for protecting the spinal cord and maintaining proper head and neck mobility. Instability at this level can lead to severe neurological deficits or even paralysis if left untreated.

The Surgical Process - Step by Step

The following is the typical process for posterior cervical fusion:

  • The patient is positioned face down, and an incision is made at the back of the neck to access the cervical spine.
  • Decompression is performed by removing bone spurs, portions of the lamina (bony arch), or other structures that may be compressing the spinal cord or nerve roots.
  • The facet joints, which are the bony protrusions on the back of each vertebra that provide stability and allow movement, are prepared for fusion. This may involve decortication (removing the outer cortical bone) to expose the cancellous (inner) bone, which promotes bone growth and fusion.
  • Bone graft material, either autograft (taken from the patient’s own body, typically the iliac crest) or allograft (from a bone bank), is placed along the decorticated facet joints to facilitate fusion.
  • Instrumentation, such as screws, rods, and plates, is then inserted to provide rigid fixation and stabilization of the vertebral segments during the fusion process.
    • Lateral mass screws are commonly used, anchoring into the lateral masses (bony protrusions on each side of the vertebra) from C3 to C7.
    • Pedicle screws offer the most biomechanically stable fixation by passing through the pedicles (bony projections) of the vertebral body, but carry a higher risk of complications.
    • Rods connect the screws, forming a rigid construct that holds the vertebrae in proper alignment while the bone graft fuses.
  • The wound is closed, and a cervical collar or brace may be used postoperatively to restrict neck movement and promote fusion.

Benefits & Risks of Posterior Cervical Fusion

Posterior cervical fusion can provide significant benefits for patients suffering from cervical spine conditions like myelopathy, instability, or deformities. The primary advantages include:

Potential Benefits

  • Decompression of the spinal cord by removing bone and ligaments, reducing symptoms like numbness, weakness, and loss of coordination in the arms/legs caused by cord compression.
  • Enhanced spinal stability by fusing the vertebral segments, preventing excessive motion that can cause pain and neurological issues. This is crucial after trauma, instability, or deformity correction.
  • Restoration of normal cervical lordosis (curvature) by using pre-contoured rods, improving spinal alignment and biomechanics.
  • Prevention of further spinal cord injury or deterioration by decompressing and stabilizing the spine.

Potential Risks

  • Neurological deficits like C5 palsy (weakness in shoulder/arm) or transient worsening due to manipulation around the spinal cord and nerve roots during decompression. Precise surgical techniques using intraoperative imaging/navigation minimize this risk.
  • Vertebral artery injury, which can be catastrophic, due to the artery’s proximity to the surgical site. Meticulous dissection and thorough anatomical knowledge are essential.
  • Typical surgical risks like infection, excessive bleeding, instrumentation failure, and pseudarthrosis (non-union).

Recovery Expectations

  • Hospital stay: Typically 1-3 days with minimally invasive techniques.
  • Immobilization: Cervical collar use for several weeks to restrict motion and allow fusion.
  • Rehabilitation: Physical therapy is crucial for regaining strength, mobility, and function over several months.
  • Fusion process: Solid fusion can take 3-6 months, with periodic imaging to monitor progress.

While posterior cervical fusion has risks, Dr. Strenge’s extensive experience, surgical precision, and advanced techniques like intraoperative navigation improve outcomes and minimize complications. With proper patient selection, reasonable expectations, and adherence to postoperative care, many patients can experience significant symptom relief and improved quality of life.

Post-Surgery Long-Term Care

After posterior cervical fusion surgery, the first few weeks of recovery are crucial to allow the fusion to heal to begin. Here is you can expect during this post-operative period:

Initial Weeks (2-6 weeks)

  • Immobilization with a rigid cervical collar is essential to restrict neck movement and allow the bone graft to fuse properly. Patients must always wear this collar, except for brief periods, like showering.
  • Pain and muscle spasms in the neck and shoulder area are common due to the surgical dissection and instrumentation. Pain medication will be prescribed to manage discomfort during this period.
  • Patients may notice some improvement in arm/hand symptoms like numbness or weakness caused by nerve compression, but full recovery can take several months.
  • Driving is prohibited for at least 2-3 weeks until cleared by the surgeon and off narcotic pain medications. Restricted activities like lifting, bending, and twisting are enforced.

Role of Physical Therapy

  • A course of physical therapy is typically started around 4-6 weeks.
  • It begins with gentle range-of-motion exercises and gradual strengthening.
  • Therapy focuses on improving neck mobility, posture, strength in the neck/shoulder muscles, and preventing compensatory movements.
  • Therapists will guide a progressive exercise program tailored to each patient’s condition and fusion progress.

Common Concerns

  • Neck pain and stiffness are expected initially but should gradually improve over several months with therapy and time.
  • Numbness, tingling or weakness in arms/hands may persist until nerve recovery is complete.
  • You may have difficulty sleeping and performing daily activities at first due to discomfort and collar use.

Ongoing Care

  • Regular follow-up appointments with imaging (X-rays/CT) are scheduled to monitor fusion status and bony healing, typically around 6 weeks, 3 months, 6 months, and 1 year.
  • Surgeons will determine appropriate collar use, activity levels, and therapy progression based on each patient’s fusion progress.
  • Open communication about concerns like persistent symptoms, wound issues, or difficulties with the recovery process is vital.

Patient involvement through adherence to postoperative precautions, active participation in physical therapy, maintaining a healthy lifestyle, and regular follow-ups with the surgeon are essential for optimal recovery and successful fusion after posterior cervical fusion surgery. A positive attitude and commitment to the rehabilitation process can greatly improve long-term outcomes.

Dr. Strenge - A Trusted Expert in Spinal Surgery

Dr. K. Brandon Strenge is a highly accomplished and fellowship-trained orthopedic spine surgeon based in Paducah, KY. He specializes in minimally invasive spinal surgery and motion-preserving procedures to treat cervical and lumbar spine disorders. He completed a prestigious spinal surgery fellowship at The Spine Institute in Santa Monica, CA, under renowned surgeons like Dr. Rick B. Delamarter, Dr. Hyun W. Bae, and Dr. Michael A. Kropf. Dr. Strenge is board-certified by the American Board of Orthopaedic Surgery, demonstrating his commitment to meeting the highest standards of education, training, and expertise. He is also an active member of several prestigious professional organizations, including the American Academy of Orthopaedic Surgeons, North American Spine Society, Society for Minimally Invasive Spine Surgery, and International Society for the Advancement of Spine Surgery.

Schedule Your Consultation with the Strenge Spine Center Today!

If you or a loved one are suffering from debilitating neck pain, numbness, weakness, or other symptoms related to cervical spine conditions, it’s time to take action and explore your treatment options. Don’t let these issues continue to impact your quality of life – schedule a consultation with Dr. K. Brandon Strenge at the Strenge Spine Center in Paducah, KY. At the Strenge Spine Center, you’ll receive personalized, comprehensive care in a state-of-the-art facility equipped with advanced imaging systems like the EOSedge and a wide range of cutting-edge spinal implants and instrumentation. From your initial consultation to post-operative rehabilitation, Dr. Strenge and his dedicated team will guide you through every step of the process, ensuring you receive the highest quality care tailored to your unique needs.

FREQUENTLY ASKED QUESTIONS

What symptoms indicate that a posterior cervical fusion might be necessary?

A posterior cervical fusion may be necessary to treat the following symptoms:

  • Cervical myelopathy (spinal cord compression) causing dysfunction in the arms or legs, such as loss of hand control, heaviness in the limbs, stiffness or unsteadiness while walking

  • Severe neck pain and burning sensation

  • Tingling, weakness, or numbness in the arms

  • Decreased fine motor skills in the hands

  • Cervical spinal instability due to fractures, dislocations, or deformities like kyphosis (abnormal forward curvature)

  • Failure of non-operative treatments to control symptoms.

How long is the hospital stay after a posterior cervical fusion surgery?

The expected length of hospital stay is relatively short, usually just 1-3 days, with an average around 1.2 days. A stay of up to a week may sometimes be required, but that is on the longer end.

How do instrumentation tools like screws and rods aid in the success of posterior cervical fusion?

Instrumentation tools like screws and rods aid posterior cervical fusion success by providing rigid fixation and stabilization of the spinal segments. Lateral mass and pedicle screws immobilize the vertebrae, while rods connect the screws to maintain alignment as bone grafts fuse. Pre-contoured rods restore cervical curvature. Plates and cages offer additional stability. This rigid instrumentation minimizes motion, allowing the bone graft to fuse properly and reducing the risk of non-union, i.e., failure of the bone to heal solidly.

What can patients do to ensure the best possible outcomes from their posterior cervical fusion surgery?

Before surgery, quit smoking, achieve optimal nutrition and weight, and make sure chronic conditions like diabetes and high blood pressure are under control. After surgery, strictly follow postoperative care instructions including activity restrictions, take medications as prescribed, use a cervical collar/brace as recommended, attend all follow-up appointments, and fully participate in physical therapy.

How effective is posterior cervical fusion in alleviating symptoms and improving quality of life?

Posterior cervical fusion with decompression results in significant clinical improvement including reduced pain, decreased disability, and improved quality of life. Successful fusion occurred in 98.25% of cases.

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