This Is SO Wrong: Neck Fusion Gone Bad

By Chris Centeno, MD /

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I have had about enough of my spine-surgery colleagues who perform a single fusion that doesn’t work and then keep digging the proverbial hole deeper and deeper by performing more fusions. Case in point this morning is a poor middle-aged woman with her whole neck fused! Now she’s miserable and has complications related to the hardware, and, frankly, the level of damage due to the surgery is so epic, I’m not sure how to help.

For Most Patients, Fusion Is More of a Business Plan than an Effective Surgery

Every joint in your spine was built to move. Fusion involves bolting one or more spinal segments together to ensure they don’t move. Most patients don’t understand that these forces must go somewhere, so they end up going above or below the fusion. This is called ASD, which means adjacent segment disease. For more info on this problem, check out my video below: 

Why do I call fusion a business plan? We have no high-level research to show it works, and we do know it carries much more significant side effects than other types of surgery. It’s also reimbursed at a much higher rate than routine surgery, hence, the skyrocketing rates of these procedures, despite experts warning that most are not needed.

The Rise of “Maxi-Fusions”

Way back when, surgeons reasoned that performing a single-level fusion was fine, but once you fused more than two segments of the spine, this could cause problems. Somewhere between that fairly reasonable approach and about five years ago, we saw the rise of what I call “maxi-fusions.” This began about the same time many surgeons got involved in owning a piece of their own hardware companies. These new fusion devices were decidedly different. Now instead of one, two, or three levels, we began to see four-, five-, and six-level devices. Small surgical scars began to transform into Grand Canyons of tissue loss in the back and neck. Something was seriously wrong.

My Patient Above Ends Up Getting Her Entire Neck Fused

When I first saw the patient above, I was stunned. Somehow, her entire neck had been fused. Who is this? She is a 51-year-old white female with a very long history of spinal surgery.

Basically, in 2004 and 2005, she had her first C5–6 fusion, which she states failed to relieve her pain. Then she had C4–5 fused and then C3–4. And then a redo C3–4 procedure, and many more surgeries, ultimately culminating in her second-to-last surgery, which was a C2 through T3 fusion. The hardware was then “sticking out” of her skin, and she had a hard time healing, so they performed a surgery where they moved the latissimus dorsi muscle to cover her fusion rod. This, of course, permanently altered the biomechanics of her body, just as each successive fusion had.

So, basically, like many patients, she began getting a single-level fusion, which then caused ASD in other levels, which also needed to be fused. Finally, they performed a “maxi-fusion,” and she’s now in my office because of headaches. More importantly, it doesn’t take a rocket scientist or a brain surgeon to figure out why she has headaches, as there is nothing left that moves other than her upper neck. This is the area where headaches originate, so it’s pretty clear that the fusion is damaging her upper neck, which causes headaches.

Regrettably, adding insult to injury, they placed one of the maxi-fusion rods too high. So the DMX study above shows that the rod bangs into her atlas (*C1 bone) every time she looks up (dashed circle). In fact, it’s already poked a small hole in that bone, leading to a new set of problems. So now she needs yet another surgery to move the misplaced rod!

The upshot? Please don’t let yourself be a victim of the fusion game. First, don’t start playing the game. If you get an opinion that you need a fusion, based on what I’ve seen through the years, there’s about an 80–90% chance your problem can be treated without fusion. If you have a fusion and they’re telling you that you need another, again, you likely don’t. More importantly, if they want to fuse more than one or two levels, run! This is almost never warranted, and you don’t want to end up like this poor woman!

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16 thoughts on “This Is SO Wrong: Neck Fusion Gone Bad

  1. chris

    This is a living nightmare, and unfortunately is only going to get worse. While these doctors are clear lunatics, at some point patients are responsible for continuing to go along with the doctors opinion. Seems like so many people don’t grasp fusion can’t be undone or the consequences.

  2. Sam

    Heartbreaking 🙁

  3. Mary Cerwick

    I had an emergency fusion between C3-C4 in my neck late August. It showed pinching on my spinal cord which was causing me myelopathy. The neurosurgeon did see narrowing as well on C4-C5 and said I may need a fusion in the future for that as well. I did see the Regenexx clinic Dr. in Des Moines and I truly respect his honesty when he said it was to risky to help me. I had no idea of any problems until the numbness began in my fingers. I am hoping that in the future I can have platelets or stem cells done instead of the surgery option, but I’m concerned that option may not exist since I have a plate and screws place in where the fusion was done. Also, if I had no pain before hand this last time, how will I know I’ll catch it early enough this time?
    I have had other treatments done at Regenexx in Des Moines and I’m forever greatful to Dr. Jackson and Dr. Goodwin for there wonderful expertise! I’m now a much stronger pain free 62 year women!
    Thanks,
    Mary

    1. Chris Centeno Post author

      Mary, we treat many post-fusion patients as well, so I would return to the Iowa clinic to get their advice on how best to proceed.

  4. Sharon

    I had a car wreck in 1983. I could have a neck fusion anytime. I asked the neurosurgeon last April how long I could go. He said until I was 80. I am 70. I do have some numbness in some fingers in the right hand. I had PRP and platelet lysate done to the facets about 2 years ago by Dr. Movva before he moved to Dallas. It did not help much whereas those treatments to my SI joint did help. It was pain free. From the article I gather your opinion is not to ever have a neck fusion? My sister had an emergency one. She was treated as a stroke patient at first. Then later had the fusion. By that time, she had lost feeling in several parts of her body. I do not want to make a bad judgment. More PRP? I had stem cells done to a knee at your clinic in Broomfield in 2010 and was a fair candidate. Only one injection done due to lack of enough stem cells. It did help that knee.

    EMAILED PATIENT

    1. Chris Centeno Post author

      Sharon, we do send patients for an occasional fusion, but that’s about 1 in 100 patients who are candidates. We would more commonly recommend surgical decompression without fusion. If PL didn’t work in your neck, it’s possible you could need surgery, but I would have to know more.

  5. Sam

    High grade lesion of anterior dura matter / tectorial membrane and/or high grade lesion of posterior dura matter / posterior atlanto-occipital membrane is often seen in patients with the upper cervical syndrome. In such cases patients literally sense that these membranes are being ripped apart with even a minimal strain (i.e. they can’t tolerate the supine position). Whereas these membranes lesion could be totally or partially secondary to the upper cervical ligaments damage, it appears that treating these membranes could be useful. Is there a way to treat the posterior dura matter / posterior atlanto-occipital membrane safely without risking a vertebral artery puncture or dural puncture/CSF leak?

    1. Regenexx Team

      Sam,
      Yes, we routinely treat the POAM.

  6. Richard

    In 2919 my wife had a C6-7 fusion. Helped but less than a year later she developed Torticollis-though no evidence fusion surgery caused it, several mds suggested some nerves could have been affected as they did an anterior cervical disc fusion.

    At this point can stem cells help her? We’ve tried meds & 2 years of Botox shots but basically a waste of time + money.

    Appreciate your thoughts.

    1. Regenexx Team

      Richard,
      Unfortunately, your wife’s experience is very common post fusion. While fusion is irreversible we can likely help. Please see: https://regenexx.com/blog/pain-after-back-fusion-adjacent-segment-disease/ and https://regenexx.com/blog/neck-epidural-failed/

  7. Sheila

    I regrettably had a anterior cervical discectemy fusion on my C6 & C7 in August of last year. I was was told I had a bone spur pressing on my nerve that was causing issues of numbness in my hands and fingers. The pain in my neck was unbearable. After 10 yrs of suffering I decided to go ahead with the surgery. Doc said once he got in my discs had partially collapsed. I came out of surgery in extreme pain as anyone would. Unless I’m the only one that was in so much pain at that point I didn’t want to go on. I had to stay over night of course in hospital. My pain was not manageable by my order meds. I was in tears. The doc straight up said most of his patients can come out taking Tylenol and ibuprofen and be fine. I only decided to do the surgery because I am so tired of having to take a pill to be able to do the things I enjoy doing. Spending time with family, grandkids, ect. I was so shocked that the doc released me in so much pain. Now not even a yr later my primary doc says my C3 & C4 are enlarged on x-ray. I can not go through another surgery. I can not physically or mentally prepare myself to do that again. My fear is it will cause new issues and I couldn’t tolorate the pain in August. I just had a cervical epidural on 20th of June and another on 27th. I have had more pain since those procedures. I know its only been a couple weeks but the side effects were horrible. Both times I got major worse than migraine headaches over my whole head. Called my doc and they said Oh it’s probably allergies. I will not be going back. I don’t know what to do at this point. When pain from surgery causes more pain then what is it worth. I have to find a better solution soon. I’m supposed to be able to talk to my doctor and get honest answers.

    1. Regenexx Team

      Hi Sheila,
      Very sorry to hear about your situation. We may be able to help, but we’d need more information. Please see: https://regenexx.com/blog/pain-after-neck-fusion-2/ To do that, please submit the Candidate form here: https://regenexx.com/conditions-treated/spine/

  8. Wendy

    That poor woman! I have heard that ASD and future fusions are common after ACDF. After almost 6 mo of constant pain in my left shoulder and arm, and loss of function and strength in left arm, MRI showed complete collapse of cervical disc. Nerves weren’t even visible on MRI, due to compression from disc.
    Had ACDF C5-C6 in Oct 2015. Immediate pain relief. Developed fairly severe dysphagia that lasted almost 3 months, limiting my diet to soft foods and soup. Healing was slow, but finally returned to work (at a different, less demanding job) in July 2016. Since then, have had no other issues.
    Over the last several months (3.5 years post-op) have had far more frequent headaches and upper back pain, around/just below fusion area (primarily left side, just as pre-ACDF). For the last week, have had continual (24/7) upper neck pain (left side, bottom of ear lobe level, guessing C2 or 3?) and limited ROM. Pain in shoulder/arm increases with sitting while feet elevated, or when leaning over (such as with tying shoes, picking things up off the floor, etc.)
    Due to the time I was off work from the initial surgery, and inability to return to that previous job (working with sometimes aggressive special needs kids/young adults) I lost the job and thus my excellent health insurance.
    My concern is ASD, though without insurance, there’s no way I can afford another $50k fusion surgery!
    So… long story short, I am curious as to a) what signs are typically present when ASD develops? How do you know it’s ASD vs just having tweaked a muscle/pinched a nerve b) beyond OTC pain meds, what are good non/minimally invasive alternatives to another fusion?
    Any thoughts or opinions are appreciated!

    1. Regenexx Team

      Hi Wendy,
      There isn’t a way to tell without the the appropriate type of evaluation that combines an extensive history and physical exam with reading the MRI directly, not the report. If ASD is the diagnosis, the least invasive treatment would likely be precise fluoroscopy guided injections of orthobiologics made from your own body to address the overloaded areas. Please see: https://regenexx.com/blog/pain-after-neck-fusion-2/ and https://regenexx.com/blog/neck-fusion-side-effects/ and https://regenexx.com/conditions-treated/spine/ and https://regenexx.com/blog/orthopedic-stem-cell-treatment/ and https://regenexx.com/our-approach/ If you’d like to set up a Candidacy review or exam, please give us a call at 855 622 7838.

  9. Brooke

    Hi I had a fusion in my neck (c3-c5that did not fuse! I’m in excruciating pain and have no mobility in my neck and cant feel my fingers!! ( more less tingling) all the time..I cant hold onto anything with my hands anymore either I drop everything…I’m miserable and just saw the neurosurgeon yesterday he ordered yet another mri and ct of my neck all the way down to my lower back where I’m also having problems! I’m only 39 years old and feel like I’m 100.. my question is what do they do for people like me who have fusions that dont work and have floating hardware hanging around In their neck?! Please HELP!!!!!

    1. Chris Centeno, MD Post author

      I would need more information to answer that question. My staff can set up a phone review to look at imaging and try to decide the best options.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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