Eight months ago I had an ACDF to fuse my neck at C56. The X-rays show movement at that segment so I need another operation. What will they do next?

Nonunion after ACDF can be followed with no further treatment required. If the patient is symptom-free and stable, then a watchful attitude may be best. On the other hand, if the movement is enough to create a pseudoarthrosis or "false joint," then a second (revision) surgery may be needed.

The surgeon will decide what's best based on your symptoms and the results of X-rays and sometimes, additional CT scans. Anterior revision surgery is one option. The surgeon goes back through the front of the neck to the fusion site. The pseudoarthrosis is removed. Bone chips or slices of bone are taken from the patient's pelvic area and used as a graft. A metal plate may also be inserted along the front of the spine between C5 and C6.

There's a fairly high rate of nonunion with anterior ACDF revision. Knowing this, some doctors are using a posterior fusion instead. Wires, plates, or rod and screws are used for the posterior surgery. There's more blood loss and a longer hospitalization but the fusion rate is excellent.

At your next appointment, ask your surgeon to explain the various options. Find out what he or she would recommend and why.