Okay, I'm thinking I might bite the bullet and have spine surgery. The surgeon will do a rotor-rooter and clean out bone spurs or anything else that might be putting pressure on my nerves. Then I'll get a neck fusion. I've already been warned that fusion stabilizes the area but also puts more pressure on the bones above and below the fused site. So my question is: how will I know if that's happening and what do they do about it?
It sounds like you are investigating the effects of a procedure called anterior cervical (neck) decompression and fusion or ACDF. The surgeon does, indeed, use special tools to remove any soft tissue or bone that is putting pressure on the spinal nerve roots as they leave the spinal canal and travel out to the arms (or legs). That's the decompression part of the procedure. The next part of the surgery uses bone graft (and sometimes metal plates and/or screws) to fuse two or more vertebrae together. Fusion is necessary to stop the pain and help stabilize the affected segments.
Pressure on the nerve tissue occurs when there's foraminal stenosis. The foramen is the opening in the bone through which the spinal nerve roots pass as they travel from the spinal cord down to the arms (or legs in the lower extremities). Stenosis means narrowing. So foraminal stenosis refers to a narrowing of the openings for the spinal nerve roots. Pressure on the nerves at this point is what causes neck pain, headaches, numbness and other symptoms suffered by patients affected by this condition.
Studies show that spinal fusion does increase the load and stress placed on the adjacent segments. Adjacent segments refer to the vertebra just above and just below the fused site. But there's been some question about whether those changes would have occurred anyway because of the natural process of aging.
A recent study comparing patients who had an ACDF with normal, healthy adults with no sign of neck problems was done to sort out how much adjacent degeneration occurs in both groups. They expected to find more cases of disc degeneration in the surgical group and that's exactly what was seen. But the surprising finding was that people in both groups (surgical and healthy normals) had signs of disc degeneration without symptoms.
So, you may not know if or when you are developing adjacent disease without an MRI to show what's going on in the spine. Any increase in painful neck, shoulder, or arm symptoms may be your first sign that problems are developing. Headaches; stiff neck and shoulders; and numbness, tingling, or weakness of the arms are other symptoms of possible pressure on spinal nerve roots from disc protrusion at another level.
See your surgeon right away if you notice any of those changes. Conservative care may be all you'll need to resolve those symptoms. Activity modification, physical therapy, and medications can help. Additional surgery may be needed but you are a long way from that at this point and don't need to worry about that just now.
Morio Matsumoto, MD, et al. Anterior Cervical Decompression and Fusion Accelerates Adjacent Segment Degeneration. In The Journal of Bone and Joint Surgery. January 2010. Vol. 35. No. 1. Pp. 36-43.
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