Anterior and Posterior Cervical Arthrodesis
THEcervical arthrodesis or cervical vertebrae is a surgical procedure that allows you to join the bones of the highest part of the spine. It is particularly indicated when the patient suffers from Cervical disc herniation, myelopathy, cervical stenosis, cervical spondylosis, tumors, infections, trauma e deformations of various nature.
How is arthrodesis of the cervical vertebrae performed?
Since the surgery is performed in general anesthesia, in the preceding hours the patient must carefully follow the fasting instructions.
The neurosurgeon, according to the problem to be treated, the conformation of the spine, the area of the cervical spine and any instability, chooses the most suitable approach for the patient: anterior or posterior or, more rarely, combined (both). Surgery generally consists of a decompression phase of the nervous system and another phase of vertebral fixation (arthrodesis) and eventual correction of deformation. The long-term goal is that the union of the bones is stable.
Cervical arthrodesis can then be performed anteriorly, therefore from the anterior side of the neck, e posteriorly. Moreover, both have pros and cons in equal measure: if cervical arthrodesis via the anterior way allows the neurosurgeon to effectively monitor the radicular (cervical nerves) and medullary compression and leads to a faster and more comfortable course, the posterior one. , although with a little longer hospitalization times, it implies less risk for the bowels, blood vessels and recurrent laryngeal nerve.
In addition, catheter and electrodes can be applied to the patient to control bladder and nerve function.
Discectomy and anterior arthrodesis
The neurosurgeon makes a horizontal or longitudinal incision on the neck and proceeds with one discectomy (excision of a cervical disc). Once the discectomy has been performed, it opens the cervical canal and the lateral foramina, removing any osteophytes (arthrosis beaks) and any disc herniation or protrusion, allowing the spinal cord and cervical nerves to be freed. You can then enter impianti in titanium or non-metallic, such as cages, plates, plate-cages fixed by screws.
As an alternative to the introduction of implants, it is therefore possible to take material, generally from the iliac crest or some vertebral elements (spinous processes and laminae), and perform a bone graft. Another solution involves using material of synthetic origin.
During the operation, which generally lasts from 30 to 90 minutes for a mono-level arthrodesis, it is also possible to intervene on more vertebrae.
Laminectomy and posterior arthrodesis
The neurosurgeon makes a longitudinal incision behind the neck, removes and moves the muscles that support the head and generally proceeds with a laminectomy (removal of the posterior part of the cervical vertebrae), allowing to open the posterior half of the cervical canal and thus to free the spinal cord.
The arthrodesis phase consists of screwing the posterior part of the vertebrae and joining them by connecting the screws with titanium bars, previously shaped according to the surgeon's choice.
The surgery generally lasts from 60 minutes to 4 hours depending on the number of vertebrae on which to intervene.
Explanatory video on discectomy and anterior cervical arthrodesis (in English)
Explanatory video on laminectomy and posterior cervical arthrodesis (in English)
Cervical arthrodesis: risks and postoperative
Immediately after the operation, the patient must remain in bed for a few hours for observation and can later get up quietly. In the following days, they will come carefully monitor the neurological situation and wound healing, to avoid possible infections. A postoperative control radiograph or CT scan will be taken.
Given the nature of the two cervical arthrodesis approaches, anterior or posterior, the possible complications vary according to the choice. After an anterior cervical arthrodesis, complications can be damage to the arteries, damage to the esophagus, dysphonia (voice disorder), dysphagia (swallowing disorder) ... It should also be remembered that metal implants can be victims of ruptures or malpositioning and in the long term the patient can develop an “adjacent segment”, a wear of the adjacent segments.
As mentioned, cervical arthrodesis and convalescence also relate differently depending on the technique used: anterior arthrodesis requires a shorter hospitalization and recovery times are faster, unlike what happens for posterior arthrodesis, which can result in more intense post-operative pain. After cervical arthrodesis surgery, the rehabilitation may require the patient to wear a support device, such as a cervical collar, for a few days. In other cases, the rest and attention to do not suddenly move your neck.
It is important to respect the deliveries that forbid carrying loads or to make efforts on the cervical spine in flexion / extension.
Muscle rehabilitation physiotherapy is recommended after any spine surgery, usually no earlier than 4-8 weeks.
