What’s a big and easily preventable cause of neck fusion complications? The curve of someone’s neck is often ignored in medicine, as the focus is usually on procedures like surgery for chronic pain. However, our understanding of the importance of this curve has been growing. Now a new study shows that if the surgeon happens to fuse a neck without a curve, bad things happen.
The term “lordosis” means curve. The normal neck has a C-shaped curve that’s critical is distributing the weight between the discs in front and the facet joints in the back. For a primer on all of these terms and parts of the spine, see my “Understanding the Spine” video. When the normal neck curve is lost, more of the weight is placed on the discs, leading to a higher risk of disc failure. Studies have also shown that restoring this neck curve once it’s been lost can help neck pain.
Given that, how important is it for surgeons to “respect the curve” when they fuse someone’s neck? The new study followed 113 patients who underwent neck fusion surgery over a four year period. The curve of the neck was measured after the surgery to see if it still had the normal curve, or was straight, or even bent in the opposite direction (kyphosis). The authors found that the lack of a normal curve was directly correlated with increasing disability. In other words, getting fused with the wrong neck curve really seemed to mess patients up.
What’s the practical reality of this problem? I’ve seen many patients like this in the clinic through the years, whose necks after fusion have no curve. They are miserable, because the head pulls forward rather being centered on the spine, leading to pulling on the neck muscles into the shoulder blades. Regrettably, outside of treating the symptoms, there’s little that can be done after the surgery to fix the issue.
The upshot? First, avoid neck fusion whenever possible. Second, if you absolutely need one of these big surgeries, make sure your surgeon is hip to the idea that the good Lord cut a curve in your neck for a good reason!