The Leg Bone's Connected to the--Neck Bone? The Success of a Surgical TechniqueIf you have neck pain from a herniated or degenerating disc, your doctor may eventually recommend surgery. Surgeons usually get to the problem disc by operating through the front of the neck. They take out the damaged part of the disc and replace it with bone from elsewhere in the patient's body or from another source. The goal of this type of surgery is for the bones to grow back together, forming one solid bone.
There is considerable variation in the success of this surgery, particularly when fusion is attempted at more than one vertebral level in the neck. Some researchers have estimated that surgeons operating on multiple levels achieve successful fusion in just under half of the cases.
This author's surgical group reports better results when using bone from the patient's lower leg (fibula) to fuse the spine. This study documents the success rate of this procedure when more than one vertebral level is fused.
One hundred forty-five patients had neck fusion surgery. All of the patients tried conservative treatment for a long period before resorting to surgery. There were about an equal number of men and women with an average age of 49 years old. Most of the patients (112) had surgery at two levels. Thirty-two had surgery at three levels, and one had surgery at four levels. After surgery, patients wore soft collars for at least three months.
Neck X-rays were taken no less than two years after surgery. All but 14 patients had solid fusions at that time. That means 90 percent of patients had good results from surgery. For each level of fusion attempted, there was a 94 percent success rate.
The number of vertebral levels involved in the surgery didn't affect patients' results in any major way. The rate for successful fusion was 92 percent for two levels and 84 percent for three levels.
The majority of patients who didn't achieve solid fusion were women. However, the difference in success rates between men and women was not felt to be significant. Also, six of the patients who didn't have solid fusions were smokers at the time of surgery. It is well known that smoking interferes with healing and lowers the chance fusion will occur.
Ten patients had complications from surgery. The author attributes the overall success of this procedure to the fact that the fibula grafts used in neck fusion have a large surface area. The larger surface area improves the body's ability to heal the graft and bones together into one solid bone. Still, the variation in reported success rates among surgeons suggests that more research is needed.
The authors are confident that fusing more than one level in the neck using bone graft from the fibula offers acceptable success rates.
Donald R. Gore, MD. The Arthrodesis Rate in Multilevel Anterior Cervical Fusions Using Autogenous Fibula. In Spine. June 1, 2001. Vol. 26. No. 11. Pp. 1259-1263.
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