If you think you might be a candidate for cervical spinal fusion, it's time to have a thoughtful conversation with your doctor. No one should approach surgery without investigating all of the options, so the time to start educating yourself is now. Spend time researching your condition to make sure you are properly prepared before you sit down for your consultation. Make a list of questions, so you don't leave anything out. If you're not sure where to begin, we've prepared the following list of questions to ask your physician about cervical spinal fusion.
1. Are there alternative treatments for my condition? If so, why are they not appropriate?
Your first question before having any surgical procedure is to confirm there are no alternative treatments available for your condition. Cervical fusion is usually undertaken when the damage and instability of the cervical vertebrae are beyond the scope of non-surgical options, such as medications (anti-inflammatories, steroids, narcotics), physical therapy, heat/cold treatments, rest, and pain management evaluation. Once non-surgical alternatives have been ruled out, the next question should focus on the fusion itself.
2. Does my condition warrant a fusion?
The decision to fuse cervical vertebrae is usually based on extensive damage to the spine or discs, resulting in instability in the neck. Other procedures, such as disc replacement, may not offer enough support for your condition. Be sure your doctor’s decision to fuse is not based on a limited scope of practice. If your doctor can only offer one surgical option, it’s time to seek a second opinion. Cervical spinal fusion should not be undertaken just because it's the only procedure your doctor knows how to perform. Having options is critical, even if those options are eliminated.
3. How do I know if a surgeon is qualified to perform cervical spinal fusion?
The best place to start is with board certification and fellowship training. Make sure your surgeon is someone who has obtained the proper education, training, and experience to perform spinal surgery. Board certification ensures he has met these rigorous criteria. Also, read the physician's reviews or ask for references from former patients who can attest to their level of care and the success of their procedure.
4. How should I prepare for surgery?
If you've chosen your surgeon and set the date for your procedure, your next step is to prepare for surgery. Your doctor will probably recommend the following steps:
- If you smoke, stop immediately. Nicotine will interfere with bone healing, and the last thing you want is to go through nicotine withdrawals while recovering from surgery.
- Have a complete physical to ensure you are healthy enough for surgery (especially important if you have preexisting conditions, e.g., cardiovascular or pulmonary disease).
- Improve your diet. A healthy body heals faster.
- Avoid certain medications, such as aspirin, NSAIDs (non-steroidal anti-inflammatory drugs, such as ibuprofen), and blood thinners (consult with your physician), since they will increase blood loss during surgery.
- Follow a recommended exercise regimen.
- Arrange for friends or family to take care of you after surgery.
Preparing your body for surgery is an important step, so get started now to make sure you’re ready.
4. What is cervical spinal fusion and how is it performed?
During cervical spinal fusion, the vertebrae are fused together to promote strength and stability in the neck. Ask your doctor which approach he will use: making the incision through the back of the neck (the less common route) or by entering through the front of the neck (anteriorly), allowing a more direct approach with less disruption of muscle tissue.
During surgery, the affected cervical vertebrae are fused with a bone graft, along with plates and screws that hold it in place, allowing the bones to eventually grow together, stabilizing the joint. Discuss with your surgeon the type of graft that will be used (autograft, allograft, or a synthetic product), since each graft has its pros and cons. The main drawback of cervical spinal fusion is loss of mobility at the joint.
5. What is minimally invasive spinal surgery and why is it preferred?
Minimally invasive spinal surgery (MISS) is performed by specially trained surgeons, guided by microscopes, utilizing very small incisions. MISS has many benefits over the conventional route. These include:
- Less trauma to surrounding tissues
- Faster healing rates
- Less blood loss
- Minimal scarring
- Faster recovery times; usually performed on an outpatient basis
- Less risk of infection; performed at a surgical center instead of a hospital
If your surgeon is not qualified in minimally invasive procedures, you should consult with one who is. Why settle for a conventional route when there is a more targeted approach that affords less risk and a faster recovery?
As you approach your cervical spinal surgery, be sure to ask the right questions, identify the right procedure, and find the right surgeon that can offer you the best chance of success.
About the author
Robert S. Bray, Jr., M.D. Nicknamed “Dr. Fix-It” by The Red Bulletin, Robert S. Bray, Jr., M.D. makes an art of helping the world’s most elite athletes return to push the boundaries of performance. The neurological spine surgeon, recognized globally for his thorough diagnoses and pioneering minimally invasive approach, is quickly redefining sports medicine, one champion at a time. Dr. Bray founded the state-of-the-art, multi-disciplinary DISC Sports & Spine Center (DISC) in 2006 located in Los Angeles, CA. Read more articles by Robert S. Bray, Jr., M.D..