In preparation for a neck fusion, I watched a videotape of the procedure at the surgeon's office. I saw that they used titanium cages between the bones. Sometimes the patient got a special metal plate to hold the cage in place, but not always. I don't really think I want that much metal inside me. Do I get a choice?
For a very long time, spinal fusion was done with bone graft material. The donor bone came from a donor bank or from the patient's own hip. This is still a common surgical approach -- especially when only one segment is being fused. No metal or hardware called instrumentation was used.
But using bone grafts as the only fusion material has some distinct disadvantages. Donor bone from a bank is expensive. And it isn't always available. Harvesting bone from the patient works well, but there can be problems with pain at the donor site.
More recently, new fixation methods have been developed and tested. These include titanium cages, plates, pedicular screws, and laminar hooks. Hardware of this type is used most often when the surgeon is fusing multiple vertebral bodies together.
Titanium cages are inserted between the two vertebrae (after the remaining disc material has been removed). If the body of the vertebral bone is removed, then it can be crushed up and put inside the cage. This will help foster new bone growth at the fusion site.
Your surgeon will direct the surgery based on how many segments are to be fused, your general health, and his or her expertise with the various procedures. Don't hesitate to bring this question up at your next pre-op session. Let your surgeon know if you have any specific preferences. Find out how much of the decision is yours to make. It's always a good idea to be informed and prepared.
Fabio Galbusera, MSEng, et al. Anterior Cervical Fusion: A Biomechanical Comparison of 4 Techniques. In Journal of Neurosurgery: Spine. November 2008. Vol. 9. No. 5. Pp. 444-449.
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