Anterior Cervical Discectomy and Fusion | Does this surgery cause more cervical spine instability and deformity?

Anterior Cervical Discectomy and Fusion complication and risks

Ross Hauser, MD

Many people come to Caring Medical because they have issues with cervical neck instability and radicular pain. It is for these reasons they have a recommendation for Anterior Cervical Discectomy and Fusion. In separate articles I discuss Cervical neck instability, and, Atlantoaxial instability, and why these conditions can send you to Anterior Cervical Discectomy and Fusion. This article will focus more on the surgical outcome of the surgery.

See our main page Prolotherapy for Neck Pain and Cervical Instability for more information about our treatments. If you have a question about cervical neck pain, you can get help and information from our Caring Medical Staff.

Anterior cervical discectomy and fusion (ACDF or sometimes anterior cervical decompression) is a cervical neck surgery that is recommended to patients that have been diagnosed with a pinched nerve in the neck that is causing pain, weakness, numbness and other symptoms of cervical radiculopathy.

At what point is fusion surgery considered “high risk”?

As I have discussed in numerous pages on this website, not only has it been shown that cervical fusion can be an inappropriate treatment for many patients, worse off, is that the fusion can do much more harm than good. One area of harm is adjacent segment disease.  This is a failed surgery condition in which the adjacent vertebrae to the fused section rapidly degenerates because of newly created surface stresses by the immobility of the fused segment.

Make no mistake, there are times where a person does need a cervical fusion. If this person suffered a severe fracture in the neck then a cervical fusion would be called for. But many times, people get cervical fusion because they have complaints that can be many times treated without the need for cervical fusion. These complaints include:

Cervical instability symptoms

In our office, on detailed physical examination, we find that many of the people who seek a consultation for the problems listed above have problems caused by ligament weakness, which causes the vertebrae to press on the nerves. This can be treated non-surgically.

But if the examination does not look for ligament problems, if the examination is focused on reading the MRI, the cervical ligaments will be overlooked. Cervical fusion will be recommended. To the patient getting a surgical consultation, surgery sounds like the only answer. It is not as we will see below.

Let’s discuss the surgery.

Anterior Cervical Discectomy and Fusion Recovery

There are many lifestyle changes following Anterior cervical discectomy and fusion.

For some, these lifestyle changes will be short-term, for others long-term, for others still indefinitely or non-ending in cases of complication and the need for revision neck surgery.

After surgery:

Understanding Anterior Cervical Discectomy and Fusion surgery, risks, complications and inappropriateness.

As mentioned above, when your cervical vertebrae are fused to limit cervical instability and related symptoms, the force and energy in your neck movements are transferred to the vertebrae below the fusion and above the fusion. This is why people suffer from the same symptom at different locations a year to 3 years later. This is why many people are sent back to surgery to fuse more segments and why many get the symptoms back and they can even be worse. Let’s explore research from some of the leading universities and research hospitals that support these findings.

Within 10 years, 1 in 4 patients is at risk of clinical adjacent segment disease.

Neck Pain After Fusion

Doctors at the University of Alberta noted in the Canadian Journal of Neurological Sciences: “Cervical spine clinical adjacent segment pathology has a reported 3% annual incidence and 26% ten-year prevalence. Its pathophysiology remains controversial, whether due to mechanical stress of a fusion segment on adjacent levels or due to patient propensity to develop progressive degenerative change.”(1)

Simply,  within 10 years, 1 in 4 patients are at risk of clinical adjacent segment disease because of unnatural stress and destructive forces being placed on the cervical spine.

Failure in stand-alone Anterior Cervical Discectomy and Fusion Implants

Doctors at the Swedish Neuroscience Institute, Swedish Medical Center, in Seattle Washington led a study examining the failure patterns in standalone Anterior Cervical Discectomy and Fusion Implants. The study appeared in the September 2017 edition of the journal World neurosurgery.(2)

Take home points:

The surgery to fix the surgery. Revision and more fusion is no easy fix

Doctors at South Korea’s Pusan National University published this research in the Journal of Korean Neurosurgical Society.

The quick points:

Patients with cervical instability are getting surgeries that cause more instability and deformity

Neck Instability

COMMENT: What these researchers are warning is that the cervical spine and its attachment to the thoracic spine are more unstable than thought. This presents a paradox, patients with cervical instability are getting surgeries that cause more instability and deformity. Here is the result of this research:

Cervical fusion – there is an option

The final outcome of a successful cervical fusion is that the vertebrae can no longer move. This will prevent the nerve from getting pinched, BUT,  the neck still moves. The neck’s motion is now transferred to the vertebrae below the fusion and above the fusion. In essence, the problem the surgery sought to fix only transferred excessive pressures to the vertebrae below it and above it. This is why people with cervical fusions inevitably, a year to three years later get the symptoms back

Now, by definition, that means if somebody is recommended a cervical fusion it means that the doctor is saying that it’s instability causing the problem. In my opinion, the best treatment for cervical instability is Prolotherapy of the neck, not cervical fusion. If it is the excessive movement of the vertebrae that is pinching on the nerves cause terrible pain, migraine headaches, vertigo, all types of symptoms, then Prolotherapy can strengthen the cervical ligament, address the symptoms and not rob the patients of their natural neck movements.

Caring Medical research on alternatives to Discectomy and Fusion

In 2014 headed by Danielle R. Steilen-Matias, PA-C, we published these findings in The Open Orthopaedics Journal.(2)

When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae.

Therefore, we propose that in many cases of chronic neck pain, the cause may be underlying joint instability due to capsular ligament laxity. Furthermore, we contend that the use of comprehensive Prolotherapy appears to be an effective treatment for chronic neck pain and cervical instability, especially when due to ligament laxity. The technique is safe and relatively non-invasive as well as efficacious in relieving chronic neck pain and its associated symptoms.

My own cervical radiculopathy and Prolotherapy treatment – Ross Hauser MD

Dr. Hauser explains his own problems with cervical instability and his treatments with Prolotherapy. With the use of digital motion X-ray, Dr. Hauser explains his non-surgical recovery.

If you have a question about options to Anterior Cervical Discectomy and Fusion, you can get help and information from our Caring Medical Staff.

1 Jack A, Hardy St-Pierre G1, Nataraj A. Adjacent Segment Pathology: Progressive Disease Course or a Product of Iatrogenic Fusion? Can J Neurol Sci. 2017 Jan;44(1):78-82. doi: 10.1017/cjn.2016.404. [Google Scholar]

2 Alonso F, Rustagi T, Schmidt C, Norvell DC, Tubbs RS, Oskouian RJ, Chapman JR, Fisahn C. Failure Patterns in Standalone Anterior Cervical Discectomy and Fusion Implants. World Neurosurgery. 2017 Sep 20. [Google Scholar]

3 Lee SH, Lee JS, Sung SK, Son DW, Lee SW, Song GS. A Lower T1 Slope as a Predictor of Subsidence in Anterior Cervical Discectomy and Fusion with Stand-Alone Cages. Journal of Korean Neurosurgical Society. 2017 Sep;60(5):567. [Google Scholar]

 

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