To fuse or not to fuse, that is the question that comes before many people with neck pain. Fusion means that the bones in the spine are bonded together with a combination of metal parts and extra bone. Before deciding to do a fusion, a surgeon and patient must discuss the risks and potential benefits. The key word is "potential" because no surgeon can guarantee a complete "fix". In fact, some surgeries can result in a complete disaster. Before someone decides to have surgery, that person must be willing to risk getting worse. What are the risks for neck fusion surgery? Many common complications arise frequently like difficulty swallowing and speaking. However, the worst complications that happen four percent of the time are death and stroke. Four percent may not seem like a lot unless you happen to fall within the four percent. What are the potential benefits? That depends on the type of neck pain. There are two broad categories of neck pain: those with neck pain alone and those with neck pain plus radiculopathy (pinched nerve).
First, for someone with neck pain alone, fusion may not be the answer. However, that depends on the level of seriousness. Some serious problems require surgery like major trauma and infection. Those potential disasters can cause permanent nerve damage and deterioration, in a hurry. Other causes of neck pain are not so sinister like symptomatic disc degeneration. For these common, relatively minor conditions, neck fusion has not been proven to be a solution according to a recent report released by the Neck Pain Task Force (Spine, 2008). Many research studies have falsely suggested that fusion is the best thing since penicillin. But, the quality of these studies falls short. Those who argue against fusion surgery for neck pain alone say that even though someone initially improved with a fusion surgery, that person might also have improved naturally. And that is something to ponder: neck pain alone, without radiculopathy or serious damage, may get better naturally, without surgery.
If someone does have a pinched nerve plus neck pain, then the opinion tide shifts somewhat in favor of surgery. The Neck Pain Task Force reported that an open surgical procedure can give rapid relief over a non-surgical approach. But, they still cautioned that the long term benefits of surgery, over a non-surgical approach, are not clear. When discussing surgery for radiculopathy, fusion by itself is not the best option because the pressure on the pinched nerve also needs to be relieved. That pressure relief comes in the form of removing some disc material (discectomy) or removing some bone (decompression laminectomy). With a combination of a neck fusion with decompression, some people can do quite well, as long as the surgery is done for the right reasons on the right person.
Who is the right person for surgery? The right person has the best chances for success. Smokers do not have successful surgeries. The frail and sick do not do well with surgery. People with uncontrolled diabetes have very little chance for success. The right person for surgery is one who is the picture of perfect health (or as close to "perfect" as possible). A smart surgeon will select their patients for surgery wisely. Of course, one can always find a surgeon willing to operate, but that may not be the best choice for that person.