Are you experiencing neck pain after cervical fusion, a surgery intended to get rid of the pain in the first place? This might understandably feel like a cruel irony. But you are not alone.
Chronic neck pain and persistent discomfort after cervical fusion can be debilitating. The good news is that they can be managed. Join us as we examine post-cervical fusion neck pain causes and management.
Understanding Cervical Fusion and Neck Pain
How do cervical fusion surgery and neck pain relate to one another? Cervical fusion is a type of surgery performed to treat neck disorders. In this sense, neck pain is one of the reasons why surgery is performed. Sometimes, though, neck pain might also appear after cervical fusion surgery as an unwanted side effect.
We begin by briefly discussing cervical fusion as a surgical procedure and neck pain as a symptom of neck disorders.
Cervical fusion, or neck fusion, is a type of spinal surgery. It can be classified into two main types:
- Anterior Cervical Fusion. This type uses the anterior approach to access the neck vertebrae. The surgeon makes an incision in the right or left side of the throat and moves the muscles aside to reach the vertebrae. Its goal is to remove an intervertebral disc and fuse vertebrae together.
- Posterior Cervical Fusion. This type uses the posterior approach to access the vertebrae. In posterior fusion, an incision is made on the back part of the neck. The goal here is to provide enough space for the nerves to exit the cervical spine.
Anterior cervical fusion is more commonly and successfully performed than the posterior approach. There are three main types of cervical fusion surgery:
- ACD (Anterior Cervical Discectomy),
- ACDF (Anterior Cervical Discectomy and Fusion), and
- ACDFI (Anterior Cervical Discectomy and Fusion with Instrumentation).
What are the differences between these techniques? In ACD, the neck vertebrae are allowed to fuse or stick to each other. A bone graft assists the fusion process in ACDF and ACDFI.
A bone graft is a bone from the patient’s own body that acts as a natural replacement for the disc. So, in ACDF and ACDFI, a bone graft replaces the degenerated cervical disc. This means that the graft enters the space between the vertebrae, sticks with them, and, thus, helps mediate their fusion. The graft can become stuck to the vertebrae by itself (in ACDF) or with the help of instruments such as screws, plates, or rods (in ACDFI).
Analyzing Post-Operative Neck Pain
If you have undergone cervical fusion surgery, there is a chance that you are now dealing with neck pain. Neck pain is a possible adverse effect that may continue or appear after neck surgery.
Studies say that more than one-third of patients who have had ACDF surgery experience persistent post-operative neck pain.
That also applies to people who underwent ACDF to treat their neck pain.
Quite ironic, right? Why should one have persistent pain even after undergoing surgery to treat the pain in the first place?
Well, it is not as straightforward. Let us explain everything step by step.
Why Does My Neck Hurt Years After Cervical Fusion Surgery?
A 2018 study analyzed neck pain in patients for one year after undergoing cervical fusion surgery. It found that patients who reported neck pain right after surgery were more likely to report persistent neck pain even up to one year later.
So, the reasons for neck pain right after surgery are probably the same as the reasons for pain years later. These may include the following factors:
- Smoking or narcotic use before surgery
- Mood disorders, such as bipolar disorder, depression, or anxiety disorder
- Unrealistic patient expectations
- Inadequate cervical decompression. In other words, the surgery did not do the right thing to fix the spinal cord and nerve compression.
- Oversized graft. The bone graft put between the vertebrae is too big.
These factors may help give doctors a first idea of which patients are at risk of developing neck pain after fusion surgery. By understanding these risks, doctors may take additional measures to prevent post-operative neck pain.
Why Do Some Experience Pain After ACDF Surgery?
Regardless of the specific procedure, including ACDF, neck surgeries often share the same risk factors for pain as we highlighted earlier.
Those include:
- Smoking habits
- Mood disorders, such as depression or anxiety
- Unrealistic patient expectations
- Inadequate cervical decompression
- Oversized grafts
Understanding the causes behind the pain after ACDF surgery can help patients set the right expectations and navigate their recovery more effectively.
What Are the Long-Term Effects of Cervical Fusion on Neck Pain?
As said, neck pain is a possible consequence of neck surgery. Now, you might probably want to know how long the neck pain lasts after neck surgery. Does it get better at all? A study published in 2023 might just give you the answer you were looking for.
The study analyzed patients neck pain and disability for 20 years after neck surgery.
The good news is that the study found that neck pain and disability improved over time.
The pain improvement index was positive in 71% of patients.
On the other hand, the disability improvement index showed improvement in 41% of them. Based on global outcome guidelines, 88% of patients showed clinical improvement.
Other studies reported similar results for postoperative neck pain and disability. These examined patient outcomes after two, six, and ten years, respectively.
The study found no change in outcomes for different techniques of ACDF. More pain and disability correlated with a lower quality of life over the years.
How Successful is Neck Fusion Surgery?
The main goal of neck fusion surgery is to decompress the spinal nerves and the spinal cord. As said, it achieves this by getting rid of the problematic intervertebral disc.
The ACDF technique is very successful and has excellent long-term outcomes. Studies say that, in general, all three cervical fusion techniques have positive outcomes and benefits.
ACD, on the other hand, has been associated with a decreased fusion level (which is not considered good) and an increased kyphosis rate. Nevertheless, many studies have supported its overall success.
Even though it is generally successful, cervical fusion surgery can cause unwanted side effects. Read along as we explain what these are.
What Are the Side Effects of Neck Fusion Surgery? Is Neck Fusion Surgery Safe?
Most patients tolerate ACDF surgery well. It relieves the symptoms of nerve compression in the majority of patients. Patients can usually go home 1–2 days after surgery. Here are the main side effects of neck fusion surgery:
- Neck pain
- Pain between the shoulder blades
- Neurological symptoms in the hands and arms. These include weakness, numbness, and tingling.
- Voice changes. Neck surgery may cause voice changes by affecting the vocal cords.
- Sore throat
- Difficulty swallowing
- Dizziness and balance problems
As for safety, on the other hand: Yes, neck fusion surgery is generally considered a safe procedure. According to a 2018 study, complications happen a little more often in procedures involving more than three vertebrae. Still, the rate of complications is low in all types of neck fusion surgery. This makes neck fusion a good treatment option for the conditions we mentioned. These adverse effects generally improve 1–4 weeks after surgery.
Now that we’ve discussed side effects, could there also be other surgical complications? Let us read below.
What Are the Complications of Neck Fusion Surgery?
What problems and complications can occur after neck fusion surgery? Complications of neck fusion surgery can be classified into the three following groups:
- Hardware and graft failures,
- Neurologic injuries, and
- Neck-related complications.
Let us talk about each of these groups.
Hardware and Graft Failures
Hardware complications come in the form of instrument failure. These failures happen in 1–20% of cases. Hardware complications include:
- Screw backout. One or more screws slipping out of their positions because they were not placed correctly or secured.
- Plate fracture. The plate instrument collapses and cracks under bone pressure after being put in place.
- Screw breakage. Screws may not withstand bone pressure and break, especially when placed incorrectly.
- Plate migration. If the plate is not secured, it may migrate or move from its initial position with movements of the spine.
Graft fusion failures, on the other hand, occur in 3–9% of cases. As the name implies, graft fusion failures mean that the body graft put in place of the removed disc fails to fuse with the vertebrae.
What Are the Symptoms of Loose Screws After Cervical Spinal Fusion?
The instrumentation used in cervical fusion to keep the graft in place may loosen and shift. As a result, the vertebrae do not fuse as they should. This may happen for various reasons, such as:
- Improper healing of bones
- Incorrect fusion of bones
- Trauma to the neck
- High-load activities, such as lifting heavy weights
- Osteopenia or osteoporosis (mild to moderate loss of bone mass)
How can you tell that a fusion screw went loose? You may feel the following symptoms:
- Neck pain that gets worse
- A noticeable bump under the skin in the neck region
- Crackling or popping sounds, which signal that the screw is irritating nearby tissues.
Neurologic Injuries
Next up: neurologic complications. These include the following:
- Tears of the dura layer, which result in cerebrospinal fluid leaking out. The dura is the outermost layer of the meninges, the protective barrier of the brain and spinal cord. If the dura and the other layers are damaged, the fluid that they hold might escape. This fluid is called the cerebrospinal (CSF) fluid.
- Spinal cord injuries. The spinal cord is an extension of the central nervous system that is located in the spinal canal. Damage and changes to vertebrae and meninges may lead to injuries to the spinal cord as well.
- Nerve root injuries or radiculopathies. Radiculopathies represent damage to the root of the spinal nerves, which exit from the spinal cord. As a result of this injury, weakness and other neurological symptoms may occur. An injury like this is certainly surgical failure, as one of the goals of neck surgery is to treat radiculopathies, not worsen them.
What Are the Symptoms of Nerve Compression?
Cervical fusion surgery for neck pain may involve one or more spinal levels. These levels range from C1 to C7 (C1, C2, C3, C4, C5, C6, C7). Compression of a particular cervical spinal nerve may lead to symptoms in particular parts of the upper body. These parts include the front and back parts of the neck, the back of the head, the upper chest, shoulders, arms, and hands.
Here are the main symptoms of C1-C7 spinal nerve compression:
- Neck or arm pain
- Numbness and weakness in the arms and hands
- Unsteady gait when walking
- Muscle spasms in the legs
- Loss of coordination in arms, hands, and fingers
- Loss of muscle tone in arms or hands
- Dropping items or losing skill in the hands
Neck-Related Complications
Finally, neck-related complications. We mentioned some of the side effects of cervical fusion, like neck pain and a sore throat. Dysphagia, or difficulty swallowing, occurs in 4–16% of cases.
Post-operative neck hematomas causing airway obstruction have also been reported. Surgeons may unintentionally damage blood vessels while performing an operation. A hematoma is a localized collection of blood after a blood vessel injury.
Esophageal perforations represent another surgical complication. A perforation occurs when the wall of the esophagus is (accidentally) pierced during the neck incision process. This creates a hole in the esophagus. From this hole, swallowed food, liquids, and saliva may escape and injure nearby organs.
What is Failed Neck Syndrome?
Failed neck and back syndrome refers to patients suffering from chronic pain after neck or back surgery. Failed neck syndrome occurs when:
- You deal with the same problem even after surgery
- Complications make your condition worse
- The implanted instruments have failed
- Bones and tissues do not heal appropriately.
What Does a Failed Neck Fusion Feel Like?
If you have a failed neck or back syndrome, you may experience sharp or dull pain in the neck, back, arms, or legs. This is because many nerves may be affected, depending on the spinal level. The nerves that supply the arms and legs come from the neck, middle back, and lower back spine.
How Do You Treat Failed Neck Surgery Syndrome?
Painkillers like NSAIDs and neuropathic pain medications, such as gabapentin, may be prescribed. Neuropathic pain is a type of pain that occurs when parts of the nervous system are damaged. As a result, harmless factors trigger a painful response, and pain is perceived as much more intense than it is.
If these medications do not work, cervical epidural steroid injections may relieve pain.
Physical therapy may also be part of the treatment plan. It improves flexibility and strengthens the core muscles.
A newer treatment option for recurrent neck pain from failed neck surgery syndrome is cervical spinal cord stimulator implantation. Studies show positive feedback from patients who undergo this type of treatment.
Sometimes, none of the methods mentioned may treat a failed neck surgery. In such cases, corrective surgery may become necessary.
Can Surgery Fix Chronic Neck Pain?
Neck pain is a common musculoskeletal problem that may result from various causes. The causes may range from injuries to degenerative diseases.
When neck pain does not go away with conservative treatment or becomes chronic, neck surgery enters the treatment scene.
The main indications for cervical fusion surgery include the following neck disorders:
- Traumatic injury to the neck part of the spine. These usually happen after car or motorcycle accidents, falls, playing sports, or weapon use.
- Radiculopathy. Radiculopathy represents damage to the nerve roots as they exit the spine.
- Myelopathy. Myelopathy is spinal cord compression. It arises from degeneration, injury, disc herniation, or from variations at birth.
- Osteomyelitis. Osteomyelitis is a term that means “bone inflammation from an infection.” If you were wondering, yes, bones may get infected too!
- Cervical spondylosis. Spondylosis is degeneration of the neck vertebrae, which usually happens as we age.
- Tumors in the vertebral bone tumors
- Damage in the posterior longitudinal ligament of the spine
- Certain cases of kyphosis. Kyphosis is a condition in which the upper part of your back is more curved than it normally should be.
How Long Does It Take to Recover From Neck Surgery?
After undergoing neck fusion surgery, you will want to recover as quickly as possible. Recovery depends on how fast your graft fuses with the vertebral bones. The faster the fusion, the faster the recovery.
When the procedure is finished, you will be released from the hospital in 1-2 days. Your doctor will keep an eye on your pain level and your ability to eat and move. Full recovery from anterior cervical fusion can take three to six months.
How Many Years Does a Neck Fusion Last?
As mentioned, cervical fusion surgery is an effective treatment method for many neck problems. It intends to provide a lifelong solution. Thus, ideally, neck fusion surgery lasts for life.
Various factors may affect the longevity of a neck fusion. The surgery type and technique, potential complications, and overall health are just some of them.
Neck pain may appear even years after undergoing surgery. One of the possible causes may be adjacent segment disease (ASD). ASD is a condition that causes degeneration in the spinal segments close to the fusion site.
Can You Live a Normal Life After Cervical Fusion Surgery?
The answer is yes! Cervical fusion surgery is meant to get rid of your neck pain and problem, not add to them. You should have no reason to feel restricted.
To ensure adequate healing and prevent neck pain from returning, you need to be careful and take some preventive measures.
Here are a few tips on how to make your recovery quick and easy:
- Follow your doctor’s advice. This one is essential. Your doctor will devise a recovery plan that works best for you. If you have any doubts, do not hesitate to contact your doctor and clear things up.
- Understand that some postoperative effects are normal. Neck pain, sore throat, and difficulty swallowing may be expected effects right after surgery. Do not panic! They usually improve in a few weeks.
- Do not take unprescribed medicine. Take only the medications that your doctor has recommended. You may want to avoid NSAIDs (like Tylenol) for a few weeks after surgery. They might interfere with the healing process.
- Keep an eye on your incision site. You may remove the dressing in three days. Ensure that you maintain proper hygiene. You may shower three days after you have had surgery.
- Wear your neck collar. This applies to you only if your doctor suggests it. A neck collar ensures your neck is immobilized. You may remove it when you shower.
- Eat soft foods. Lend your throat a hand by making swallowing easier. Take small bites and chew your food before swallowing.
- Avoid smoking. Nicotine may slow down the healing process.
- Avoid driving and lifting weights. Driving requires looking around and moving your neck, while lifting puts a load on your neck. This is why these activities are not safe for a while after neck fusion surgery.
Recovery from neck fusion surgery and neck pain may understandably burden your mental health. But the good news is that it is up to you to make sure it goes as smoothly as possible!
Note: We urge you to seek urgent medical care if you experience any of the following effects:
- Difficult breathing
- Chest pain
- Excessive neck swelling
- New weakness after surgery
Takeaway
Cervical fusion is a type of surgery performed to treat neck disorders. Neck pain is one of the reasons why surgery is performed. Neck pain might also appear as an unwanted side effect after cervical fusion surgery.
Cervical fusion can be classified into two main types: anterior and posterior. Anterior cervical fusion is more commonly and successfully performed than the posterior approach.
Neck fusion surgery is a generally safe procedure. The ACDF technique is very successful and has excellent long-term outcomes.
Over one-third of patients undergoing ACDF surgery experience persistent post-operative neck pain. The causes of post-operative neck pain may include a few different factors, such as:
- Smoking or narcotic use before surgery
- Mood disorders, such as bipolar disorder, depression, or anxiety disorder
- Unrealistic patient expectations
- Inadequate decompression
- Oversized graft
Most patients who undergo cervical fusion surgery are clinically improved long-term.
Complications of neck fusion surgery can be classified into the three following groups:
- Hardware and graft failures,
- Neurologic injuries, and
- Neck-related complications.
Failed neck and back syndrome refers to patients suffering from chronic pain after neck or back surgery.
Full recovery from anterior cervical fusion can take three to six months. To ensure adequate healing and prevent neck pain from returning, you should take some preventive measures.
Ideally, neck fusion surgery lasts for life.
