(This is the the section that explains the detail of the operation or procedure above and should be read in conjunction with the section called your neck operation).

There are several reasons for performing a posterior neck fusion. The general theme that runs through the most reasons however is that it is performed for instability of the cervical spine (neck). In some cases it is following trauma causing instability to the cervical spine, in other cases it is because the surgery required to decompress the nerves is so extensive that it causes instability. In still other cases it is because the cervical spine has become unstable because of a degenerative (wear and tear) condition such as rheumatoid arthritis.

There are many different techniques depending on the preference of the surgeon and on the pathology that needs to be treated. There are techniques using wires where the spinous processes (see anatomy chapter) or the facet joints (see anatomy chapter) are used to attached to each other to stabilise the spine. Other techniques use metal clamps that hook on to the laminas. Stronger and more versatile tecniques are made possible by putting screws into the lateral mass. This is the bit of bone that supports the facet joints and contains the tunnel that the vertebral artery runs through. Another technique is to put screws into the pedicles of the cervical vertebrae.

It is frequently neccessary to decompress the nerves before the fusion. Please see the chapter on laminectomy and laminotomy for a description of this part of the operation.

When undergoing this operation you will be lying on your stoamcah and the surgeon will be operating from the back of your neck. Your skin will be sterilised with a combination of Iodine and an alcohol solution and then the area will be covered by sterile drapes. An incision will be made and the tissue will be carefully separated up to the spine.

At this point a decompression procedure may or may not be performed by removing the laminas (see the section on laminectomies). Following that, the fusion technique that is appropriate for both you and your surgeon will be carried out. Please see the pictures on the following pages for a description of the different techniques. The most important feature in spinal fusions are that the instrumentation that is used should correct the alignment of the spine and stabilise the spine while the bone that is used as a bone graft grows and forms a full fusion. This is excactly the case as in lumbar fusion operations.

The main aim with a fusion operation is to achieve a bony fusion between the vertebrae involved. If this is not the case, then the operation is not a success and another operation might have to be performed in the future. Bone growth is variable and depends on many factors and is different in different people. It is usually asumed that bone growth takes place from six weeks onwards and significant boen growth usually only occurs at about three to four months.

A drainage pipe will be placed in the wound and connected to a reservoir. This will allow all excess blood to drain away.
Following the operation, you will be taken to the recovery room to recover from your anaesthetic. Thereafter you will be monitored for several hours more to ensure that no blood clot forms under the skin of your neck. You may mobilise after the operation as soon as your surgeon allows this and will usually be from the day following your operation The staff will administer analgesia for any discomfort that you may experience.

Ward care

In the ward you may walk around freely. You might be expected to wear a neck collar to keep the spine stable in the direct post operative period and you might be expected to wear it for six weeks.
You will usually be seen by the physiotherapist that will show you neck exercises. Please see the section on neck exercises that is included in this book. The drainage pipe in your neck will usually be removed on the day after the operation or rarely the next day.

Discharge

You would normally be discharged two or three days after surgery with analgesia to take home. A painful throat and even some hoarseness can be quite common and can last for as much as a few months, but usually only lasts a few days. Wound care will be discussed with you by your surgeon.

Rehabilitation

It is incredibly important to get a lot of rest and exercise following your surgery. Do not try to rush back to work. It is important to walk for exercise and also exercise in conjunction with the guidelines from your physiotherapist. You may perform normal activities and should only wear a neck brace if your doctor prescribes it. You should refrain from exercises that involve impact for three months. This would include jogging, mountain biking and equestrian pursuits.

Follow up

You will usually be seen after six weeks but will be seen earlier if there are any complications. You would usually undergo an X-ray of your neck a few months after the operation to evaluate the bone growth between the two vertebrae. It is important that this bony growth takes place; otherwise the operation might have to be repeated.