Posterior Cervical (Lateral Mass) Fusion

lateral mass fixation - side view

Procedure

Fusion of the back of the vertebrae of the cervical spine excluding the first two (C1 and C2). The part in the vertebra where the screws are inserted is called ‘lateral mass’. Decompression can be done at the same time if necessary. This technique can be combined with fusion of C1 and C2 and the head (occipito-cervical fusion). How many levels are included in the fusion depends on the underlying problem but in principle can include fusion of any number of vertebrae to the entire cervical spine in rare cases. In some cases it is combines with an anterior cervical fusion for additional stability.

Indications

Instability or deformity of the cervical spine, trauma or rarely for muscular disorders like myasthenia gravis (‘floppy head syndrome’).

Risks

Infection, bleeding, CSF leak, neurological damage including paralysis, stroke, no improvement of symptoms, death in cases of high cervical cord, failure of inserted metal work requiring further surgery, damage of the muscles in the back of the neck causing neck pain. The very serious risks are small. The risk of failure of the fusion also depends on the quality of the underlying bone.

Hospital stay

2-3 days after operation in majority of cases.

Anaesthesia

Always general anaesthesia

Recovery

The neck might feel sore for a short time. A collar is not routinely necessary if x-rays after the operation are satisfactory but depends on the underlying condition and extend of surgery.

Commonly asked questions

How much will the operation effect my neck movements?

This depends largely on how many levels have been fused. Fusion of a single level has usually little impact on the overall movement.

What are the long term risks?

Fusion of a single level has normally no significant impact on neck movement. This is because the other levels compensate for this. The more levels the fusion involves, the higher is the excess movement of the remaining levels. This means there is a risk that these levels wear out sooner than they would normally. This is called adjacent level disease. This is the case with fusion of any level in the spine.