I'm looking into the newest treatment for neck fusion. What's available and what do you recommend?
Anterior cervical discectomy and fusion (ACDF) is the procedure used most often to fuse the cervical spine (neck). ACDF is used for neck problems such as cervical radiculopathy, disc herniations, fractures, and spinal instability.
In this procedure, the surgeon enters the neck from the front (the anterior region) and removes a spinal disc. This portion of the operation is called a discectomy. The vertebrae above and below the disc are then held in place with bone graft and sometimes metal hardware.
The surgeon inserts the bone graft material into the space between the two vertebrae where the disc was removed. This space is called the interbody space. The goal of the procedure is to stimulate the vertebrae to grow together into one solid bone (known as fusion). Fusion creates a rigid and immovable column of bone in the problem section of the spine. This type of procedure is used to try and reduce neck pain and other symptoms.
There are several ways this procedure can be done. There is the autograft stand-alone procedure, the autograft with anterior (front of the spine) plate, and interbody cage supported by an anterior plate. Each of these approaches has its own benefits and disadvantages, which your surgeon can discuss with you.
Metal cages used in between the vertebral bones are usually filled with bone chips that will eventually grow together to support the fusion. Cages support the load and maintain spine height. These can be used as a stand-alone procedure (just the cage) but studies show results are much better when cages are accompanied by anterior metal plates (along the front of the fusion site).
One of the newest and latest developments in this procedure is the use of an artificial (substitute) bone graft. Substitute bone eliminates the long-term pain and discomfort that often occurs with bone graft taken from the patient's hip.
The goal for the future is to develop a cage or other fusion device that doesn't require the additional plating. This would decrease or even eliminate problems with plating such as difficulty swallowing and degeneration that often occurs at the spinal level next to the fused area.
Your surgeon is the best one to advise you on first, whether a fusion is the best treatment approach for you and two, if so, which surgical technique is best for you. Each patient should be evaluated individually with consideration given in the selection of treatment based on patient characteristics. Age, activity level, patient goals and expectations, bone health, and underlying cause of the problem are all important factors that must be weighed-in when making treatment decisions involving cervical spine fusion.