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POSTERIOR CERVICAL FUSION (PCF)

Overview:

A posterior cervical fusion is a surgical technique repairing the cervical spine using a posterior (back of the neck) approach.  The PCF is most commonly performed on patients with cervical fractures or significant instability.  It can also be performed for spinal tumors, infections, or deformity.  PCF may also be used in conjunction with the anterior cervical surgery, especially when multiples levels of the cervical spine are involved.

Procedure:

Patients are positioned in the prone (lying on the stomach) position, generally using a special operating table/bed with special padding and supports. The surgical region (neck area) is cleansed with a special cleaning solution. Sterile drapes are placed, and the surgical team wears sterile surgical attire such as gowns and gloves to maintain a bacteria-free environment.

A 3-6 inch (depending on the number of levels) posterior (back of the neck) longitudinal incision is made in the midline, directly over the involved spinal level(s). The fascia and muscle is gently divided, exposing the spinous processes and spine bones. An x-ray is obtained to confirm the appropriate spinal levels to be fused. A laminectomy (removal of lamina portion of bone) and foraminotomy (removal of bone spurs near where the nerve comes through the hole of the spine bone) can be performed if necessary. Two small metal screws can be affixed to each spine bone, one on each side, which are then connected together with a titanium metal rod on each side of the spine. The bony surfaces and facet joints are then decorticated and bone graft is placed, which mends together over time (weeks and months).

The wound area is usually washed out with sterile water containing antibiotics. The deep fascial layer and subcutaneous layers are closed with strong sutures. The skin can usually be closed using sutures or staples. A sterile bandage is applied.

The total surgery time is approximately 2-4 hours, depending on the number of spinal levels involved.

Post-Op Care:

Most patients go home in 3-5 days after surgery.  Patients are instructed to avoid excessive bending or twisting of the neck for the first 1-2 months following surgery.  Patients are instructed to avoid heavy lifting 2-4 months after surgery.  Most patients are required to wear a neck brace or collar after surgery to reduce the stress of the neck area, decrease pain, and improve bone healing.

Showering/Bathing:

Patients can shower immediately after surgery, but should keep the incision covered with a bandage to avoid direct contact with water.  Patients are not advised to take a bath until granted permission by Dr. Beer at the 2 week follow up appointment.

Return to Work/Sports:

Patients may return to light work duties as early as 2-4 weeks after surgery, depending on when the surgical pain has subsided. Patients may return to moderate level work and light recreational sports as early as 3 months after surgery, if the surgical pain has subsided and the neck strength and mobility has returned appropriately with physical therapy. Patients who have undergone cervical fusion at only one level may return to heavy lifting and sports activities if the surgical pain has subsided and the neck strength and mobility has returned appropriately with physical therapy. Patients who have undergone cervical fusion at two or more levels are generally recommended to avoid heavy lifting, laborious work, and impact sports.