Anterior cervical fusion is when a surgeon joins two or more vertebrae into one continuous segment of bone. This fusion is known as an arthrodesis, and it is done for a variety of reasons such as a neck fracture or for conditions such as spinal stenosis. Similar to all surgical interventions, it has its own risk of complications that must be weighed by the patient before agreeing to the procedure.
Bleeding
Bleeding is a risk of any surgical intervention in which tissue cutting occurs. In addition, the surgeon can damage blood vessels near the surgical site, causing additional bleeding during the surgery. The risk of bleeding is increased in patients with congenital bleeding disorders such as hemophilia and in patients taking blood thinning medication, such as warfarin.
Infection
Infection is also a universal risk of any surgical procedure. It can range from infection of superficial tissue such as the skin to deeper tissues, including the spine. Treatment can range from simple to extremely complex, depending on the site of infection in the body.
Nonunion
Nonunion occurs when the intended fusion between bones does not occur. The medical term for nonunion is pseudoarthrosis. As a result of the failed fusion, instability between the joints can occur with resulting damage to other tissues. Symptoms can range from pain to neurologic disruptions, depending on the involved tissue. Often this necessitates repeat surgery with possible use of plates and screws to ensure graft stability.
Graft Problems
Often the fusion between bones is achieved by taking bone tissue from another site in the body and using it to hold adjacent vertebrae together. A common site to extract such bone tissue from is the hip bone. Sometimes the bone graft can shift, which can cause instability of the spine. Surgery must be done to correct this complication before irreversible damage occurs.
Nerve Damage
Damage to nerves can may occur when a surgeon is working in a sensitive location such as the spinal cord. The medical term for this complication is radiculopathy. Possible causes of nerve damage include direct trauma from the surgeon, scar tissue formation after surgery, and swelling from inflamed tissues in and around the surgical site. Symptoms vary from sensory disruptions such as tingling and numbness to limb weakness. Because the surgery is being done in the cervical region, the upper limbs tend to be more involved than the lower, but symptoms can occur almost anywhere in the body.
Anesthetic Complications
Anesthesia is an important part of the surgery and carries its own inherent risks. Allergic reactions can occur with any medication and range from urticaria (hives), itching and swelling to possible anaphylactic shock. In addition, a reaction known as malignant hyperthermia can occur with certain anesthetics and is characterized by muscle rigidity, increased temperature and heart rate, and high blood pressure.
Blood Clots
Blood clots, especially in the deep veins of the leg, may occur after almost any type of surgery. They may cause local symptoms such as pain, redness and swelling in the legs or dislodge and cause problems elsewhere in the body. The most troubling example is if the clot dislodges and ends up in the lungs; this is known as pulmonary embolus. It results in chest pain, low blood pressure and decreased oxygenation of the blood and can be life threatening. Prevention is a primary goal of all surgeons, and possibilities include the use of compressive stockings or blood thinners such as warfarin.
References
- Campbell's Operative Orthopaedics, 11th Edition; Canale & Beaty; 2007
- Skeletal Trauma, 4th Edition; Browner; 2008
