Anterior Cervical Discectomy and Fusion | Are patients with cervical instability getting surgeries that cause more instability and deformity?

Anterior Cervical Discectomy and Fusion complication and risks

Ross Hauser, MD

In this article we will explore some of the complications of cervical neck instability and abnormal positioning that put the patient at high risk for Anterior Cervical Discectomy and Fusion complication and unwanted side effects.

If you have a question about cervical neck pain, you can get help and information from our Caring Medical Staff.

Many people come to Caring Medical and Rehabilitation Services 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, at more detail. This article will focus on the Anterior Cervical Discectomy and Fusion.

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.

Failure patterns in standalone Anterior Cervical Discectomy and Fusion Implants

Doctors at the Swedish Neuroscience Institute, Swedish Medical Center, in Seattle Washington lead 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.(1)

Take home points:

They suggest to help these patients surgeons should follow these guidelines:

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

The quick points:

COMMENT: What these researchers are warning is that the cervical spine and its connection 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:

Axis - the most important bone in the cervical spine

Is the neck too weak for cervical fusion? The problem is cervical instability

This is the point of contention. In the previous studies, cervical neck instability and abnormal positioning put the patient at high risk for surgical complications.

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 for the patient, 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 the adjacent vertebrae to the fused section rapidly degenerates because of newly created surface stresses by the immobility of the fused segment.

There are times where a person actually does need a cervical fusion. If they had a severe fracture of the bones in the neck then a cervical fusion would be called for. But many times people get cervical fusion because they have complaints of ringing in the ears that doesn’t go away, vertigo, terrible neck pain, terrible migraines and they’re found to have cervical instability which cause the vertebrae to press on the nerves. So cervical fusion is recommended to prevent this by cutting away the bone and then fusing the bone to prevent it in the future from once again pressing on the nerves.

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.

Cervical fusion and adjacent segment disease

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. Please continue with my article Cervical pain | Adjacent segment disease following neck surgery

If you have a question about cervical neck pain, you can get help and information from our Caring Medical Staff.

1 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]

2 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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