Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine
For relieve spinal pain, doctors usually prescribe conservative treatment as first-line therapy. If this fails, surgery is possible. L'arthrodesis is a surgical technique that often helps to reduce neck pain. In this article, we will focus entirely on thearthrodesiscervical : indications, procedure, complications, postoperative course and rehabilitation.
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Definition of cervical arthrodesis
THEarthrodesis is a surgical operation that involves immobilize a joint. More precisely, it makes it possible to merge two vertebrae (or even more when the lesion affects several vertebrae).
on the cervical vertebrae: we speak ofarthrodesiscervical.
THEcervical arthrodesis is a surgical technique reserved for the treatment of persistent or chronic neck pain. It combines gestures of liberation and stabilization.
What are the indications for cervical arthrodesis?
Most of the time, thearthrodesiscervical is prescribed only when the effectiveness of the medications or infiltration proves to be insufficient in the management of neck pain. Also, physiotherapy and other sessions (osteopathy, chiropractic, etc.) have generally been attempted without success.
However, in rare cases, it is used in first intention, in particular if it is an emergency. The same is true for nerve damage.
In addition to these exceptional cases, this type of arthrodesis also intervenes in the treatment of ailments of cervical spine as well as their complications. These include, among others:
The surgeon can perform Cervical arthrodesis by anterior or posterior approach.
In the first case, he makes a skin incision in the neck. And in the second case, the incision is made from the back. In both cases, the skin opening is only a few centimeters, ranging from 3 to 5 cm. Generally, the doctor prescribes anterior cervical arthrodesis.
To reach the painful disc, the surgeon performs a dissection of the surrounding tissues and vessels. For more details, he can use a radioscopy, a microscope or an optical magnification.
With forceps, he removes the disc suspected of being responsible for the symptoms of neck pain. He then places an implant to fill the disc space. It is an intersomatic cage which allows the fusion of two adjacent vertebrae. It is attached to the vertebrae with fins or a screwed plate. This implant contains a bone substitute or autografts.
Once the procedure is complete, the surgeon uses an absorbable suture to close the skin. If necessary, it can install a drain.
This surgery takes place in an operating room. It is done under general anesthesia. It lasts 1 to 2 hours.
Then, you are admitted to the recovery room for 2 to 3 hours before returning to your room. Most often, you enter the clinic the day before the operation.
What are the possible complications following cervical arthrodesis?
The possible complications during cervical arthrodesis are numerous. However, they rarely occur and can be controlled.
On the one hand, complications can be related to general anesthesia and scarring.
On the other hand, they can follow the said intervention.
This surgical technique can cause breach in the dura mater that must be taken care of immediately.
Un hematoma may appear. This requires a new intervention. Indeed, it can cause suffocation. The risks associated with this type of complication tend to decrease over time. They are higher in the first hours after the intervention.
The pain may persist. This may be due to impingement withdrawal failure or axonal neuropathic damage.
La consolidation may be absent, especially in smokers. This absence can lead to chronic pain. Worse, it can cause hardware fracture or disassembly.
Cervical arthrodesis can expose to risks of esophageal compression which can cause trouble swallowing.
Surgical follow-up and rehabilitation in the event of cervical arthrodesis
The postoperative course and rehabilitation vary according to the cervical arthrodesis technique chosen during the operation.
Anterior cervical arthrodesis
In general, the pain disappears quickly after surgery. It can disappear on waking, just as it can diminish over the days. The postoperative course is usually accompanied by a analgesic treatment to control pain.
When a drainage system has been put in place during the operation, it is removed for the next 24 hours.
Returning home can be done right after the drain is removed. Thus, you can return 24 hours after your operation. Despite this, you must follow certain recommendations:
resumption of solid food is possible when you can swallow liquids without difficulty;
a nurse must redo your dressing every 48 hours until your wound is completely healed;
to limit inopportune movements, you can wear a neck brace or a foam collar with analgesic aim for 1 month;
avoid intense physical exertion during the first months;
resuming sport is only possible after 3 to 6 months of your operation, except in the case of contact sports (rugby or boxing) where you will have to wait even longer;
the resumption of your professional activity may depend on various parameters: your condition, your job, the route you have to take and your age.
La post-operative rehabilitation is not always prescribed in the context of cervical arthrodesis. In general, the recovery is going well. However, kinesitherapy (physiotherapy) can be interesting to accelerate healing, optimize the return to daily activities, and prevent the risk of complications.
Cervical arthrodesis by posterior approach
Unlike anterior neck pain, posterior neck pain take longer to disappear.
As for the period of hospitalization, it can last 48-72 hours. Your exit is therefore not possible before this deadline if you suffer a arthrodesis by posterior approach.
If a drainage system is put in place, it can be removed within 1 to 2 days after the operation. A month after that, you should arrange a check-up appointment with your doctor.
In general, you can put yourself in a sitting or standing position with the help of a medical accompaniment. This is possible the day after the operation, or even the same day.
Also, your dressing should be changed every 48 hours until your wound has healed.
The recommendations for rehabilitation work after a posterior approach apply especially in the context of a lumbar arthrodesis. It consists of performing strengthening exercises and learning the right postures. For this, you must follow all the instructions of your surgeon as well as those of your physiotherapist.
Three months after your operation, you can resume a sports activity. Nevertheless, the opinion of your surgeon remains very important. It is the same for the resumption of your professional activity. In the majority of cases, it takes 4 to 5 months of convalescence. This period may be extended for trades that require the carrying of heavy loads.
My name is Arotoky and I am studying human medicine. Web editor for more than 5 years, I currently focus on the theme of health and well-being. I have the strong conviction that with my valuable articles, I can help many people to relieve their ailments and feel better. My goal is to share my health knowledge with the general public through web writing.
