Head / Spine

Your Neck: At Risk for Pain

Until it hurts, you don’t think much about your neck. But the neck is the head’s lifeline to the rest of the body. It holds the spinal cord as well as nerves and blood vessels. It also supports the head, which can weigh 15 pounds. With stresses such as poor posture, tension, wear and tear, and accidents, it’s no wonder your neck is at risk of pain and injury. This booklet can help you understand neck problems and their treatments.

Common Symptoms

If you have a neck problem, you may not be able to move your head without some discomfort. You may have one or more of these symptoms:

Pain or stiffness in your neck
Pain in your head, arms, and shoulders
Tingling or numbness in your fingers
Frequent headaches
Dizziness
Nausea

You Can Get Relief

If you have neck pain, see your healthcare provider so you can learn the cause and get help. The treatment plan you are given can then help give you relief from your symptoms. Many neck problems improve with self-care. Your healthcare provider may also prescribe physical therapy and exercises. You can also learn ways to avoid neck problems in the future.

Your Medical Exam

Your healthcare provider needs to examine you to find the cause of your neck problem. During your visit, your healthcare provider will ask about your medical history and give you a physical exam. Diagnostic tests may also be done. Once your neck problem is diagnosed, your healthcare provider can suggest the best treatment for you.

Medical History

Your answers to your healthcare provider’s questions can provide important clues about your neck problem. You may be asked:

When did your pain start?
Were you injured?
What were you doing before the pain started?
Have you had a problem like this before? If so, how was it treated?
Where exactly does it hurt?
Does the pain stay in one place? Or does it move to your face, shoulders, arms, or chest?
How often does it hurt? Is it constant, or does it come and go?
What motions cause pain?

Physical Exam

To see which movements cause pain, you will be asked to move your head in different ways. Your posture and spine will be checked. To test the health of the nerves that run down your neck and arms, your healthcare provider may prick your hands and arms with a pin.

Diagnostic Tests

Tests may be done to help your healthcare provider confirm a diagnosis.

X-rays are pictures that show the bones of the neck.
MRI (magnetic resonance imaging) produces images that show tears, inflammation, and changes in disks, nerves, and bone.
CT (computed tomography) produces more detailed images of bone than x-rays.
Myelograms are special x-rays of the spinal cord and nerves, during which contrast dye is injected into the spine.
Blood tests may also be done.

Know Your Neck

A healthy neck is strong and flexible. It keeps your head and spine in balance for good posture. Bones, muscles, and disks in the neck work together to give your head and neck their mobility, or range of motion. When any of these parts is damaged, you may find yourself unable to move your head, shoulders, or arms without having pain.

Anatomy of the Neck

The neck contains a stack of 7 bones called vertebrae. These make up the upper or cervical spine. The spinal cord passes through a large opening in the center of each vertebra It connects the brain with the nerves of the body. Nerves branch from the spinal cord through small openings in the sides of vertebrae. Each opening is called a foramen.

Each vertebra has a bony-bump that you can feel in the back of your neck. This is called a spinous process. Separating the vertebrae are disks. These tough elastic pads absorb the shock of movement Vertebrae meet at joints called facets. These facets allow the vertebrae to move. Ligaments connect vertebrae to each other.

Special Note

Pressure on nerves in the neck can cause pain or tingling in other parts of your body. This pain (called referred pain) can reach the scalp, face, ears, shoulders, arms, hands, fingers, or even the chest.

Muscles of the Neck

Muscles in the neck support your head and hold your vertebrae in place. Muscles in your shoulders, chest, and back help move and support the vertebrae. When you move your head and neck, muscles shorten (contract) on one side and stretch on the other. When your muscles shorten suddenly without your help, you have a painful muscle spasm. This can be caused by stress or by other neck problems.

Neck in Action

Your neck moves more than any other part of your spine. Its range of motion is based on three basic moves: forward and backward (flexion and extension), side to side (rotation), and head to shoulder (lateral bending). These basic movements can be combined in countless ways. But a painful neck can limit your range of motion.

Flexion and Extension

Moving your head forward is called flexion. Moving it backward is called extension. Your disks compress with these movements.

Rotation

When you rotate your head, your head rotates on the axis, which is part of a vertebra in your neck.

Lateral Bending

When you tilt your head, the three vertebrae in the middle of your neck do the most bending The foramina narrow on the side the head is tilted toward.

Posture and Stress

A painful, stiff neck may result from poor posture or emotional stress. With poor posture, your neck curves forward. This forces your neck muscles to tighten to support your heavy head. When you’re stressed about situations in your life, certain muscles in your neck and shoulders can tighten. When the neck muscles stay tightened, your neck hurts. There are things you can do to help improve your posture and relieve stress.

Practice Good Posture

When you have good posture, your neck, head, and spine are in alignment. If you hunch your shoulders or are in a job that requires you to lean over, your head moves forward. This can make neck muscles tired and sore. The only cure is improved neck alignment while sitting, standing, and sleeping. To help maintain good posture, try the following tips:

Sitting

Sit with your feet flat on the floor or on a footrcst, such as a phone book. Your knees should be slightly lower than your hips. Don’t sit with your wallet in your back pocket.
Use a neck roll to help support your neck.
Make sure your lower back is supported. Use a back roll or rolled-up towel.
While driving, make sure your back and head are supported. Don’t strain to reach the pedals.
Avoid sitting or driving for too long. Take frequent breaks. Try to do the exercises on pages 14 and 15 at least once a day.
Set up your computer desk or workstation so your monitor is at eye level. If you’re looking at papers while you type, use a stand so the papers are at eye level as well.

Standing

Try to keep your ears, shoulders, and hips in a line when walking or standing
If you stand for long periods of time, put one foot on a low stool. Change feet often to keep pressure off your spine.
To lower yourself, bend at the knees with a straight back.
Work at eye level. Use a ladder instead of reaching up and tilting your head back.

Sleeping

Sleep or rest on a firm mattress.
Avoid using too high a pillow or lying on your stomach. These may cause a “crick” (pain) in your neck.
To help keep your spine aligned, lie on your side with your knees bent and a pillow between them. Or lie on your back with a pillow under your knees.
Use a cervical roll or cervical pillow under your neck.

Relieve Stress

Emotional stress can be brought on by a number of things. You may be worried about your job or your family. Or you may be feeling angry, sad, or afraid about something in your life. This stres.s can show up as pain or muscle tension in your neck. It can also make existing injuries more painful. You can take steps to relieve and control your stress. Try these tips:

Take a walk at lunch to get away from the pressures of work.
Get plenty of regular exercise.
Picture yourself in a place you’d like to be. Or, if you can, take a short trip.
Learn how to manage your time.
Get a massage to help relax your neck and shoulder muscles.
Talk to a friend or counselor about your stress.

Wear and Tear

As you grow older, neck problems can occur from daily wear and tear. This is called disk degeneration. Worn vertebrae can result in swollen joints or arthritis. A worn disk may bulge or tear. This is called a herniated disk.

Disk Degeneration

As disks wear out, or degenerate, they become narrow and less elastic. This means they are not able to cushion the vertebrae as well as they used to. When disks wear down, vertebrae may rub against each other. This can cause growths called bone spurs to form. These spurs can pinch a nearby nerve, causing pain.

The Process of Disk Degeneration

Arthritis

With overuse, the joints become swollen and stiff. This is a form of arthritis. It can reduce your neck’s range of motion. The swollen tissue around the joint may also squeeze the nerves in the foramina, causing pain.

Herniated Disk

A worn disk sometimes bulges or tears. The damaged portion of this herniated disk may press on a nerve. This can cause pain or weakness in your arm. A herniated disk can also be caused by an injury or by sudden movement.

Special Note

Treatment usually brings results in about 6 to 8 weeks.
Your treatment may include the self-care measures on pages 10 and 11.
It is common for problems to return.

Sprains and Other Injuries

The neck can be injured if it is forced to move past its normal range of motion. When this happens, the muscles and ligaments in the neck stretch and tear. This is called a sprain. Other neck injuries can occur if you hit something headfirst. If your neck is injured, see a healthcare provider right away to get a diagnosis and begin treatment.

Whiplash

One common neck injury is a sprain. This is also known as “whiplash.” Car accidents are the main cause. When a car is hit from behind the passenger’s head may snap backward, then forward. This is called hyperextension. If a car hits a solid object, the head may jerk forward then backward This is called hyperflexion. With a sprain, you may feel only slight discomfort at first. But stiffness and pain become more severe a few hours later.

Special Note

Most whiplash victims recover within about 3 months. Problems may recur.

Other Injuries

The neck can also be injured if the head strikes something with great force. Sports account for many neck injuries. In football, using the head to block is a frequent cause of injury. Diving into shallow water or striking a submerged object are dangers, too. Falls at work and car accidents are also main causes of neck injuries.

Treating Neck Pain: Self-Care

With most neck problems, it’s the pressure from the weight of your head that causes much of the pain. This pain causes muscle spasms, which increase your discomfort. The best way to break this cycle and stop the pain is to relieve the pressure and spasms. Your healthcare provider may suggest one or more of the following home treatments.

Breaking the Cycle of Pain

Lying down is one of the easiest things you can do to help relieve pain. This gives the muscles a chance to recover. To support your neck, rest or sleep with a cervical roll or cervical pillow under your neck. When resting or sleeping, lie on vour side or back, not on vour stomach.

Home traction may be recommended. Traction takes the weight off neck muscles, disks, and nerves. It can also stretch tight neck muscles and give squeezed blood vessels and nerves room. Follow your healthcare provider’s instructions about what type of traction to buy and how to use it. It may take a week or two for traction to relieve your pain. If pain increases, call your healthcare provider.

Relief of Muscle Spasms

Spasms are sudden, prolonged, and painful muscle contractions. You may feel the small knots of tissue in your neck. These knots are also called trigger points. Treatments for spasms include heat, ice, exercise, and medicine. Your healthcare provider will advise you about which treatments may be best for you.

Heat relaxes sore muscles and increases circulation. It can be applied to the painful area with a wet towel or during a bath or shower. Use heat before traction, exercise, or massage to make those treatments more effective.
Ice relieves small “knots” and decreases inflammation in your neck. Put ice in a bag. wrap it in a damp towel, and apply it to the trigger point.
Exercises can help relax the muscles and prevent stiffness. Drape a hot, wet towel around your neck and shoulders. Then try the range-of-motion exercises on page 14.
Medicines may be prescribed for pain. These include anti-inflammatones. such as ibuprofen, aspirin, or other medicines. Certain medicines may need to be taken regularly for conditions such as arthritis.

Other Neck Pain Relief

Massage may be advised for severe neck pain. It provides short-term relief. After a shower, gently rub your neck for up to 15 minutes. Try using lotion to prevent skin irritation.

Treating Neck Pain: Physical Therapy

Your healthcare provider may suggest physical therapy as part of your treatment. Physical therapists are specially trained to treat problems such as neck injuries. Therapy can help relieve pain, strengthen muscles, improve spinal alignment, and increase mobility. After evaluating your neck problem, your therapist will plan a program for you.

Treatments

Your physical therapist may use one or more of these methods to treat your neck problem:

Heat. A special heating pad called a cervical pack may be applied to your neck Diathermy and ultrasound use special devices to heat deeper tissues They can be used on the neck or on areas of referred pain.
Exercises. Your therapist may teach you special exercises to help strengthen your neck and improve its range of motion.
Mobilization. With this technique, the therapist gently moves your vertebrae. This helps restore motion to your neck joints
Traction. A traction machine may be used to relieve pressure in your neck.
Electrical stimulation. This equipment applies electrical impulses to your neck to decrease soreness and inflammation.
Massage. You lie flat while the therapist gently rubs your neck and shoulders.

Special Note

Your therapist may teach you about the cervical spine, proper posture, and the effects of a neck problem. This will help you help yourself to a faster, safer recovery.

Further Diagnostic Tests

Sometimes more tests are needed to help detect the cause of your neck pain. These tests include magnetic resonance imaging (MRI), computed tomography (CT), nerve conduction studies, electromyography, and myelography. The MRI and CT scans will most likely be done at an imaging center or hospital radiology department. The other tests may be done in your healthcare provider’s office.

MRI

This test uses magnetic fields and radio waves to make images of your neck. The MRI machine produces images of soft tissue, such as muscle, disks, and nerves. You lie inside the machine on a padded table.

CT Scan

This test uses a special scanner and computer to produce images of bones and soft tissue, such as nerves and blood vessels. You lie inside the CT machine on a padded table.

Nerve Conduction Studies and Electromyography

These studies help find out which, if any, nerves in your neck are affected by an injury. One or more needles are placed in the arm muscles. Wires attached to the needles measure the electrical activity of the nerves. Because it takes time for signs of nerve damage to appear, these tests are not done until a few weeks after an injury.

Myelography

This test is done to produce clearer images of nerves. Dye is used to outline the spinal cord and cervical nerves. Then a special x-ray (myelogram) is taken to showr where there may be pressure on nerves.

Home Exercises

To stretch and strengthen your neck muscles, your treatment plan may include doing neck exercises like those shown here. Apply moist heat to your neck before you start. Then do 5 sets of each exercise. 3 times a day. Stop any exercise that causes pain. Do only those exercises recommended by your healthcare provider or physical therapist.

Helpful Hints for a Healthy Neck

Help your neck out by following these tips. They’ll make a real difference in how you and your neck feel:

Follow your treatment plan faithfully.
Keep your neck strong and problem free by doing simple exercises.
Use good posture to keep your neck straight.
Take frequent breaks from sitting or standing.
Play it safe: Use protective equipment in rough sports. Always check the depth of the water before you dive.
Practice safety at work and at home. Watch out for hazards that can cause trips and falls.

Tumors of the Spine:

Tumors of the spine are usually metastatic, meaning they originate from a primary tumor elsewhere in the body and spread to the spine via the lymph nodes or bloodstream. Tumors can grow into the spinal cord causing neurological problems. In addition, tumors may destroy vertebral bodies causing collapse and thus, local or radiating pain.

Symptoms:

Back pain caused by destroyed bone
Radiating leg pain or weakness
Neurological problems

Causes:

Growth of a primary tumor in a vertebral body
Spread of distant primary organ tumors to the spine
Growth of tumors into spinal canal
Collapse of vertebral bodies causing nerve pressure

Possible Treatment Options

Non Operative Treatment

Chemotherapy and radiation are sometimes needed. Surgery can be considered for those who do not improve.

Anterior Vertebral Body Replacement

Surgical instruments are used to remove tumor and affected vertebrae. Once the tumor is removed, a metal implant is inserted to help provide stability and replace the void caused by the removed tumor.

Laminectomy and Instrumentation

Performed when a tumor has spread to the spine and is pushing on the spinal cord. The laminectomy removes a portion of the bone pushing on the nerves or spinal cord causing pain. Instrumentation is often used to help provide additional stability.

Sciatica:

Sciatica is the irritation of the largest nerve in the body, the sciatic nerve. The sciatic nerve begins with several nerves in the lower back and travels down the legs. This irritation can stem from a disc herniation, inflammation, bone spurs or foramina] stenosis. Pain occurs when any or all of these conditions compress the nerve roots or spinal cord.

Symptoms:

Irritation in one leg often down to the foot
Shooting leg pain
Weakness or numbness
Burning leg pain
Pain is usually worse when sitting

Causes:

Degeneration or rupture of a disc
Development of bone spurs or thick ligaments H Normal aging process
Sudden twisting
Episode of heavy lifting
Other physical trauma

Possible Treatment Options

Non Operative Treament

Medications, physical therapy or spinal cortisone injections are indeicated for pain relief. Surgery can be considered for those who do not improve

Decompression

This surgical procedure involves removing all or portions of the lamina, removing bone spurs and/or enlarging foramina to help relieve pressure or compression on the nerve roots or spinal chord. This pressure is often the cuase of pain.

Decompression & Posterolateral Fusion

Often times, in addition to decompression your surgeon will perform an instrumented posterolateral fusion by inserting a series of screws and rods coupled with the placement of bone graft. This fusion provides increased spinal stability.

Anterior Lumbar Interbody Fusion (ALIF)

The surgical approach is from the front of the abdomen. Once the exposure is made, surgical instruments are used to remove the disc material causing the nerve compression. Once this material is removed, an interbody cage or bone spacer is placed at the disc site filled with bone graft. The vertebral bodies above and below are frequently put under compression to aid in the subsequent spinal fusion.

Posterior Transforaminal Interbody Fusion

The same procedure as the ALIF but the approach and exposure are performed from the back. Just as in an ALIF, the disc material is removed and an interbody device is inserted. Compression through the use of pedicle screws is frequently achieved to aid in fusion.

Spondylolisthesis

Description:

Spondylolisthesis is defined as a slip of one vertebral body relative to an adjacent vertebral body. This spinal condition most commonly presents as a degenerative disease in adults but may be present in adolescents as a result of deformity or trauma.

Often there is mild to moderate back pain. If the slip is compressing a nerve, leg pain often develops.

Symptoms:

A change in the position of the vertebra can lead to back pain. Nerve compression may occur as the condition worsens, resulting in leg pain.

Lower back pain
Leg pain and numbness may develop if there is nerve compression

Causes:

Adults

Arthritic changes
Disc degeneration
Pars defect

Adolescents

Trauma due to athletic activities
Congenital deformity
Isthmic Spondylolisthesis

Possible Treatment Options

Non Operative Treatment

Medications, physical therapy or spinal cortisone injections are indicated for pain relief. Surgery can be considered for those who do not improve.

Decompression

This procedure involves removing all or a portion of the lamina, removing bone spurs and/or enlarging the foramen to relieve pressure on the nerve roots or spinal cord. This pressure is often the source of pain.

Posterolateral Fusion

Usually, in addition to a decompression, your surgeon will also perform an instrumented posterolateral fusion by inserting a series of rods and screws coupled with the placement of bone graft. This fusion provides increased spinal stability. Depending on the severity of the slip and degree of malalignment, the slipped vertebral body is sometimes pulled back to its original position using special instrumentation.

Stenosis

Description:

Stenosis is a narrowing of the spinal canal or the foramen, the opening through which nerve roots pass. Stenosis can develop in any area of the spine.

Degenerative changes in the spine, a collapsed disc, bone spurs, or cysts can cause the spinal canal to narrow. This narrowing places pressure on the nerve roots and/or spinal cord, often resulting in pain.

Symptoms:

Cervical

Stiffness in neck
Weakness in arms causing difficulty using the hands
Pain and Numbness in hands and/or arms

Lumbar

Tired, heavy feeling in back, buttocks, and legs while walking or standing
Cramping sensation in these areas
Decreased walking due to weakness, numbness or pain in legs

Causes:

Cervical

Arthritic changes in neck
Bone spurs push on nerves and spinal cord
Compression can be caused by large disc herniations

Lumbar

Degenerative changes limit nerve space; lack of blood supply induces symptoms

Possible Treatment Options

Non Operative Treatment

Medications, physical therapy or spinal cortisone injections are indicated for pain relief. Surgery can be considered for those who do not improve.

Cervical Laminectomy

Spinous process and lamina are removed to help decrease pressure on spinal cord. Instrumentation can be used to help ensure stability.

Lumbar Decompression

This procedure involves removing all or portions of the lamina, removing bone spurs and/or enlarging foramen to help relieve pressure or compression on the nerve roots or spinal cord.

This pressure often is the cause of the pain

Decompression & Posterolateral Fusion

Often times, in addition to a decompression, your surgeon will perform an instrumented posterolateral fusion by inserting a series of screws and rods coupled with the placement of a bone graft. This fusion helps to provide increased spinal stability.

Anterior Lumbar Interbody Fusion (ALIF)

Posterior Transforaminal Interbody Fusion

Osteoporosis of the Spine

Description:

Osteoporosis most commonly occurs in older women, and is a result of the loss of bone density, which weakens normal bone. Osteoporosis typically occurs in the spine and hips. The loss of bone strength, particularly in the elderly, can lead to spine fractures following minimal trauma. These fractures can be very painful and often heal in a position that may lead to increasing curvature of the spine (kyphosis).

Symptoms:

Sudden onset of sharp back pains brought on by fractured bone
Loss of height
Abnormal curvature of spine

Causes:

Loss of calcium or lack of vitamin D
Women susceptible after menopause
Mild trauma
Age
Family history

Possible Treatment Options

Non Operative Treatment

Medications are sometimes needed.

There are currently no surgical treatment options to treat osteoporosis. Non-surgical options should be discussed with your physician.

Treatment

Spinal Fusion

Planning for Spinal Fusion Surgery

Living with a problem back or neck can be frustrating. Pain may keep you from doing what you like or need to do. You may have tried other treatments, including surgery, which didn’t relieve your pain. Now, you and your doctor have decided that spinal fusion may be the best way to control your pain. Spinal fusion permanently connects two or more bones in your spine. This booklet lets you know what to expect before, during, and after your surgery.

Your Painful Spine

Back or neck problems can have many causes. They include:

Damage from overuse
Damage from an injury
Medical problems such as arthritis

No matter what the cause, the weakness, numbness, or pain that you feel is disrupting your life. You may find it hard to do your job, exercise, or keep up with your daily errands. And your family and social life may be strained as a result. But relief may be within reach.

Spinal Fusion May Help

During spinal fusion, your surgeon locks together, or fuses, some of the bones in your spine. This limits the movement of these bones, which may help relieve your pain. Your back or neck won’t be quite as flexible. Even so, you may feel more flexible after a fusion because you can move with less pain.

Types of Spinal Fusion Surgery

Which section of the spine is fused depends on where your pain is. Sections of the spine that may be fused include:

The neck (called cervical fusion)
The lower back (called lumbar fusion)

Anatomy of a Normal Spine

Learning about your spine can help you better understand how spinal fusion surgery works. The spine is made up of hard bones (vertebrae) with soft cushioning (disks) between them. This makes the spine strong and flexible.

The parts of the spine

The vertebrae are the 24 bones that connect like puzzle pieces to make up the spine
The transverse process is the wing of bone on either side of each vertebrae
The spinous process is the part of each vertebrae you can feel through your skin
A disk lies between each of the vertebrae

Fusing the Vertebrae

Normally, the vertebrae fit together but can move separately. Sometimes, vertebrae move too much, squeezing nerves and causing pain. Spinal fusion locks two or more vertebrae together. The fused vertebrae can no longer move separately as a result, pain is lessened.

Understanding Bone Graft

To fuse the spine, very small pices of extra bone are needed. Called bone graft, this bone acts as a cement that fuses the vertebrae together. Bone graft comes from a bone bank or from your own body. Your surgeon will choose the type of graft that’s best for you.

From a Bone Bank

Bone banks collect, evaluate, and store bone. The bone comes from human donors who are recently deceased.
Donors are checked for their cause of death and medical history. Tests are done to check for viruses such as HIV and hepatitis. The bone is also treated before it is used as a graft. The risk of getting a disease from bone graft is very slight.

From Your Own Body

If bone from your own body is used, a small amount of bone is taken from the surface of the front or back of your pelvic bone.
The bone is removed during the fusion surgery—a separate surgery is not needed. Bone may be taken through the incision made for your fusion, or through a separate incision. The area the bone is taken from can hurt quite a bit until it heals.
Bone from your own body may work better than bone from a bone bank. Your surgeon will decide whether it is a better choice for your fusion.

Preparing for Fusion Surgery

Below are guidelines for getting ready for your spinal fusion surgery. Follow these and any other instructions you’re given. If you have questions, ask your nurse or doctor.

Your Medical Checkup

You may be told to see your primary care doctor to make sure you’re in good shape for surgery. Tell your doctor what medications you take. This includes over-the-counter drugs like cold medicine and aspirin. Ask your doctor and surgeon if you should stop taking any medications before surgery.

Storing Your Blood

Talk with your doctor about managing blood loss. You may be able to donate your own blood ahead of time. Or, you could receive blood donated by another person. In some cases, a drug called epoetin alfa is given before surgery to help reduce the need for transfusion.

Preparing Your Home

To make life after surgery easier, get your home ready ahead of time. The tips below can help.

Put things where you can get them without reaching or bending.
Pick up clutter. Remove throw rugs. Tape down electrical cords.
Arrange for someone to help you with chores after the surgery.

Stop Smoking and Stop Taking Aspirin

If you smoke, your bones may not fuse. At least 3 to 4 weeks before surgery, stop smoking or cut down as much as you can.
Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory medications (NSAIDs) can make you bleed more during surgery. They may also keep your bones from fusing. Ask your doctor if and when you should stop taking them.

The Night Before Your Surgery

Unless told otherwise, don’t eat or drink anything after midnight. This includes water, coffee, chewing gum, and mints. If you take a daily medication and have been told to continue it, take it with small sips of water. You can brush your teeth the morning of surgery.

Arriving and Getting Ready

You’ll most likely arrive at the hospital a few hours before your surgery. If you have not preregistered, you will be given forms to fill out. After you change into a gown, certain tests may be done. Then, one or more IV (intravenous) lines may be started. These lines provide the fluids and medications you need during surgery.

Anesthesia

At the start of your surgery, you’ll be given general anesthesia. This medication will make you “sleep” through the surgery. An anesthesiologist or nurse anesthetist is in charge of the anesthesia. He or she may meet with you before the surgery begins to talk to you and answer your questions.

Risks and Complications

The risks and possible complications of spinal fusion surgery include:

Infection (less common in cervical fusion)
Nerve damage
Bone graft shifting out of place
Bones not fusing
Blood clots in legs

Cervical Fusion

Fusing vertebrae in the cervical curve may help ease neck and arm pain. Two or more vertebrae in your neck are fused. Cervical fusion is usually done through an incision in the front of the neck. It may sometimes be done through the back of the neck, or through both the front and back. The surgery generally takes from 1 to 4 hours.

The Fusion Procedure

These steps apply to fusion from the front of the neck:

The disk is removed from between the vertebrae.
Bone graft is packed into the now-empty space between the
In time, the graft and the bone around it will grow into a solid unit.
To help keep your spine steady and promote fusion, extra support (see below) may be used.
The incision is closed with sutures or staples.

If Extra Support Is Needed

Metal supports called instrumentation may be used to help steady your spine while it fuses. These supports are not removed. Your surgeon may use one or more types of support. The most common type of support used with cervical fusion is a plate.

Anterior Lumbar Fusion

Fusing vertebrae in the lumbar curve may help ease lower back and leg pain. Anterior lumbar fusion is done through an incision in your stomach area. Depending on how many vertebrae are fused, the surgery may take from 3 to 8 hours.

The Fusion Procedure

The disk is removed from between the vertebrae to be fused.
Bone graft is packed into the now-empty space between the vertebrae. In time, the graft and the bone around it grow into one solid unit.
To help keep your spine steady and promote fusion, extra support (see below) may be used.
The incision is closed with sutures or staples.

If Extra Support Is Needed

Posterior Lumbar Fusion

Fusing vertebrae in the lumbar curve may help ease lower back and leg pain. Posterior lumbar fusion is done through an incision in your back. The graft is put between the vertebrae in one of two places: in the disk space or between the transverse processes. Depending on how many vertebrae are fused, the surgery may take from 3 to 8 hours.

Fusing the Transverse Processes

Bone graft is packed between the transverse processes (“wings”) on the sides of the vertebrae. Occasionally, other nearby parts of the vertebrae are fused as well.
To help keep your spine steady and promote fusion, extra support (see page 11) may be used.
The incision is closed with sutures or staples.

Fusing the Disk Space

The disk between the vertebrae is removed.
Bone graft is packed in the now-empty space between the vertebrae. In time, the graft and the bone around it grow into a solid unit.
To help keep your spine steady and promote fusion, extra support (see below) may be used.
The incision is then closed with sutures or staples.

If Extra Support Is Needed

Metal supports called instrumentation may be used to help steady your spine while it fuses. Your surgeon may use one or more types of support. Below are two common types of support used with posterior lumbar fusion:

A cage may be used when fusing the disk space.
Screws and rods may be used when fusing the transverse processes. In rare cases, these supports may be removed after fusion is complete.

Recovering in the Hospital

After the surgery, you’ll go to the PACU (postanesthesia care unit). This is sometimes called the recovery room. You’ll stay there until you are fully awake, usually a few hours. Then you’ll go to your room. With cervical fusion, you may go home the next day. With lumbar fusion, you may stay in the hospital for 2 to 7 days.

In the PACU

When you first wake up from surgery, you may feel groggy, thirsty, or cold. Your throat may feel sore. You may have tubes in your body to drain blood and fluid from your incision. IV lines continue to provide fluids and medications. You may also have a tube called a catheter to drain your bladder for a few days.

In Your Hospital Room

You’ll be encouraged to get up and walk. At first you’ll need help, and you may not get far. But walking helps keep your blood moving and your lungs clear of fluid.
Your IV gives you fluids and nutrition until you can eat on your own, usually within a few days.
You may wear special stockings or boots to prevent blood clots in your legs.
You may be given a neck collar or back brace. Wear this as your doctor instructs.
You may see a physical therapist, who will teach you how to protect your spine when you move.

Managing Your Pain

Your nurse may give you your pain medication. Or you may have a PCA (patient-controlled analgesia) pump. This allows you to control your own pain medication. When you push a button, medication is pumped through an IV line. At first, you may feel some pain even with medication. This is normal. But if you are very uncomfortable, tell your nurse.

Recovering at Home

If you’ve had neck surgery, recovery takes about 3 months. For lower back surgery, recovery takes about 6 months to a year. To help protect your healing spine during this time, follow the guidelines on this page and any other directions you’ve been given.

Use Pain Medication As Directed

You’ll be prescribed medication for pain. Don’t wait for the pain to get bad before you take your pain medication. Take it as directed and on time. Depending on your surgery, you may need this medication for 1 to 3 weeks or longer.

See Your Surgeon

Visits after surgery let your surgeon keep track of your healing. If your stitches or staples weren’t taken out before you left the hospital, they may be removed at one of these visits.

Get Moving

The right kind of movement can help your recovery.

Take a few short walks each day. Increase your walking time as you heal.
If you feel more pain than usual after an activity, you may have overdone it. Take it a little easier for a few hours.
Ask your surgeon what activities to avoid. Also ask when you can return to work, driving, and sex.
You may see a physical therapist who will teach you how to move after surgery. He or she may also teach you exercises to help you heal.

When to Call the Surgeon

Call if you have any of these symptoms during your recovery:

Increased pain, redness, or drainage from the incision
Fever over 100°F

Moving Safely

Learning how to move safely can help protect your spine while it heals. After you heal, keep moving safely to help your neck and back stay healthy. Keep your ears, shoulders, and hips in line. Try the tips on these pages. Also, be sure to follow any other guidelines from your doctor, surgeon, or physical therapist.

Standing and Turning

Stand with one foot slightly in front of the other, as if you just took a step. Or, stand with your feet shoulder width apart.
Keep your knees relaxed and your stomach muscles tight.
Turn with your feet, not your body.

Getting In and Out of a Chair

To sit down:

Back up to the chair. Tighten your stomach muscles.
Lean forward from your hips (not from your waist).
Use your leg muscles to lower yourself onto the front of the chair. Then scoot back.
To get up from a chair:
Scoot to the front of the chair. Tighten your stomach muscles. Place one foot slightly in front of the other.
Hold the side of the chair or the armrests for support.
Bend at the hips (not the waist). Use your leg muscles to push your body up.
Lying in Bed
Lie on your back with a pillow under your knees.
Or lie on your side, with your knees toward your chest and a pillow between your knees.

Turning in Bed

Tighten your stomach muscles. Bend your knees slightly toward your chest.
Roll to one side, keeping your ears, shoulders, and hips in line. Be careful not to bend or twist at the waist.

Getting out of Bed

Tighten stomach muscles. Turn onto your side.
Slowly scoot to the edge of the bed.
Push your body up with one elbow and the other hand. At the same time, gently swing both legs to the floor. Keep your stomach muscles tight.
To stand up, follow the instructions for getting out of a chair.

Other Tips to Protect Your Spine

Bend your knees if you need to pick something up off the floor. Keep your back straight.
You may find it easier to dress and undress while lying on your back. Bend your knees and raise one leg at a time. A tool called a dressing reacher may help.
Avoid pushing, pulling, or twisting. Also avoid lifting anything heavy. Ask your surgeon for specific guidelines.
Walk to stay in shape and keep your spine healthy.