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.