Understanding Chronic Neck Pain After Cervical Fusion

Medically Reviewed By:

Dr. Chaz Fausel, MD

Dr. Chaz Fausel is a Denver-based interventional orthopedics specialist and Regenexx educator, trained at Emory and the Centeno-Schultz Clinic.

Cervical fusion is a common surgical approach that limits motion between vertebrae in the cervical spine. Physicians often recommend it to address structural concerns such as degenerative disc disease, disc herniation, or instability in the neck that may contribute to pain or nerve-related symptoms.

While this procedure may help stabilize the spine, some individuals continue to report discomfort following surgery. In certain cases, symptoms may shift or new issues may arise in adjacent spinal segments. For others, the original problem may persist despite the fusion.

This article explores research-based insights into why chronic neck pain may continue after cervical fusion and what factors could contribute to ongoing or changing symptoms over time.

What Happens During A Neck Fusion Surgery?

Cervical fusion is a surgical procedure that permanently connects two or more vertebrae in the neck to reduce movement in the affected area. The cervical spine consists of seven vertebrae, separated by discs and connected by facet joints that allow the neck to bend, twist, and rotate.

During the procedure, a physician removes one or more spinal discs and places bone graft material or a spacer in the disc space. To support the fusion process, hardware such as plates, screws, or rods is used to stabilize the vertebrae. Over time, the bone material may help the vertebrae grow together into a single, solid segment. 

Why Does Neck Pain Persist After Cervical Surgery?

Some individuals continue to experience neck pain following cervical fusion, even when post-surgical imaging suggests the procedure was technically successful. In some instances, symptoms may shift to nearby segments of the spine. In others, discomfort may remain unchanged or gradually increase.

Ongoing pain is often associated with changes in how the spine distributes stress and moves after fusion. Reduced motion in one area may place additional strain on surrounding joints, muscles, or discs. Below are some of the explanations for persistent pain after cervical fusion and factors that may influence symptom progression over time.

Failed Fusion (Non-union)

In some cases, the vertebrae may not successfully fuse after surgery. This condition, referred to as non-union or pseudarthrosis, results in continued movement at the treated segment. While surgical hardware may provide temporary stabilization, the absence of complete bone growth can allow instability to persist.

This ongoing motion may contribute to mechanical pain, inflammation, or irritation of nearby nerves. Diagnostic imaging, such as a CT scan, is often used to assess whether a solid bone bridge has formed at the fusion site. Non-union is more likely in individuals with certain risk factors, including a history of smoking, osteoporosis, or reduced bone density.

Scar Tissue Formation

Scar tissue may develop near the surgical site as part of the body’s natural healing response. This tissue can sometimes form around spinal nerves and contribute to ongoing discomfort by causing irritation or mild compression.

When scar tissue surrounds or adheres to a nerve root, a condition sometimes called epidural fibrosis, it may interfere with normal nerve signaling and lead to pain, tingling, or reduced mobility. These symptoms can resemble those experienced before surgery, making it difficult to distinguish between the original condition and post-surgical changes.

Hardware Complications

Cervical fusion typically involves the placement of hardware, such as screws, rods, or plates, to stabilize the spine. These components may sometimes loosen, shift, or press against surrounding tissues.

Such changes can contribute to discomfort at the surgical site or along nearby nerves. Hardware may also irritate nearby muscles or soft tissue in certain individuals, especially those with limited space around the spine. Imaging studies can help evaluate whether hardware-related issues are contributing to ongoing symptoms.

Nerve Damage

Cervical fusion may carry a risk of nerve irritation or injury during or after the procedure. Nerves can become compressed, stretched, or affected by nearby inflammation or structural changes. In some cases, symptoms appear immediately; in others, they develop over time.

Nerve-related symptoms may include pain, numbness, tingling, or muscle weakness. The severity and location typically depend on which nerve root is involved. Recovery outcomes vary and may be incomplete if there is a disruption to normal nerve signaling.

Muscle Strain

Following cervical fusion, muscles near the surgical site may compensate for reduced motion in the spine. This added demand can lead to fatigue, tightness, or muscle spasms over time.

Muscle-related discomfort may include localized pain, stiffness, or reduced range of motion. In some cases, chronic strain develops as the body adapts to altered joint mechanics or prolonged postural changes after surgery.

Infection

Infection is a potential complication following cervical fusion surgery. It may develop at the skin’s surface, around the implanted hardware, or deeper within the surgical area. Even when detected early, infection can interfere with healing and contribute to persistent pain.

Symptoms may include redness, swelling, warmth, drainage, or fever. In some cases, low-grade infections progress gradually and cause ongoing discomfort without clear external signs. Imaging studies and lab testing may help to confirm infection and guide further care.

Problems Associated With Adjacent Segment Disease After Surgery

Cervical fusion alters the way mechanical forces move through the spine. When the fusion limits motion at one segment, the adjacent levels absorb more stress than their structure typically allows. Over time, this added demand may lead to structural changes and symptoms associated with a condition called adjacent segment disease (ASD).

Common issues associated with ASD include:

• Bone Spurs: New bone growth may develop in response to stress, sometimes pressing against nearby nerves and causing radiating pain.

• Facet Joint Arthritis: Additional strain can accelerate wear in the facet joints, potentially leading to inflammation and nerve-related symptoms.

• Disc Degeneration: Increased pressure on nearby discs may lead to the breakdown of cushioning tissue, contributing to stiffness, reduced flexibility, or discomfort.

Research suggests that cervical fusion can affect spinal alignment beyond the surgical area. In some individuals, these changes extend downward, potentially impacting posture and function. One high-level study found no measurable improvement at two-year and five-year follow-ups, indicating that long-term benefits may vary.

When To Seek Medical Attention

Some discomfort is normal as the body heals after cervical fusion. However, specific symptoms may indicate a complication that requires evaluation by a qualified physician, such as those in the licensed Regenexx network. Early recognition of these signs may help prevent further issues from developing.

Individuals should seek medical attention if any of the following symptoms occur:

• Pain That Worsens Over Time: Increasing or persistent pain may be related to hardware complications, nerve irritation, or incomplete bone fusion.
  
• New Or Worsening Nerve-Related Symptoms: Tingling, numbness, or muscle weakness may suggest changes in nerve function or ongoing compression.
  
• Difficulty Swallowing Or Breathing: These symptoms may be associated with swelling or pressure near the airway or esophagus, possibly linked to hardware placement.
  
• Signs Of Infection: Redness, warmth, discharge, or fever near the surgical site may indicate an infection that requires prompt evaluation.

Diagnosis And Evaluation Of Post-Cervical Fusion Pain

When neck pain persists after cervical fusion, a comprehensive evaluation can help identify the source of ongoing symptoms. Physicians in the licensed Regenexx network may use a combination of physical assessment and advanced diagnostic tools to evaluate structural, neurological, and mechanical factors.

Common diagnostic methods include:

• Physical Evaluation: Physicians assess posture, range of motion, muscle strength, and pain response to identify functional limitations or areas of tenderness.
  
• Electromyography (EMG): This test measures electrical signals in muscles and nerves to detect possible nerve compression or impaired function.
  
• Imaging Tests: X-rays, MRI, and CT scans help evaluate spinal alignment, hardware positioning, bone fusion progress, and potential nerve involvement.
  
• Bone Scan: A bone scan may identify inflammation, infection, or abnormal stress at the fusion site or nearby spinal segments.

How Early Diagnosis And Treatment Improve Recovery Outcomes

Identifying and addressing post-surgical concerns early may help promote improved long-term outcomes. Timely evaluation can reduce the likelihood of worsening symptoms, support spinal function, and help preserve quality of life. Potential benefits of early diagnosis and treatment include:

• Supports Spinal Function And Reduces Stress: Early rehab may improve muscle strength and spinal balance, potentially reducing adjacent segment stress and delaying functional decline or further procedures.

• Improved Treatment Response: Early intervention is often associated with reduced pain, more efficient recovery, and fewer complications.^[1]

• Fewer Long-Term Effects: Left untreated, chronic pain can contribute to muscle weakness, joint stiffness, and postural issues that may become more difficult to manage over time.
  
• May Reduce Need For Further Surgery: While not guaranteed, early diagnosis allows time for conservative care—potentially managing symptoms and delaying or avoiding more invasive surgical interventions.

Available Treatment Options 

Several treatment approaches can help reduce symptoms following cervical fusion. The right option depends on the underlying cause, severity of symptoms, and the individual’s overall spine health.

• Medications: Anti-inflammatory medications or muscle relaxants may help reduce inflammation and ease muscle tension.

• Physical Therapy: Physical therapists may recommend targeted exercises and manual techniques to improve mobility, strengthen supporting muscles, and reduce strain on the neck.

• Alternative And Complementary Methods: Therapies such as acupuncture or massage may offer symptom relief by addressing soft tissue imbalances and promoting circulation.

• Steroid Injections: Corticosteroid injections may help reduce inflammation around irritated nerves or joints, providing temporary relief in some cases.

• Nerve Blocks: These targeted injections interrupt pain signals and can help identify or manage nerve-related symptoms.

• Spinal Cord Stimulation (SCS): A device delivers low-level electrical signals to the spinal cord to modify how the brain perceives pain.
  
• SurgicalRevision: When conservative methods fail, revision surgery may address structural or hardware-related issues from the initial procedure.
  
  • Revision Cervical Fusion: A second cervical spine fusion may be needed if the initial procedure fails, such as in cases of non-union, recurring disc problems, or instability. This may involve anterior (ACDF), posterior, or combined approaches.
    
  • Cervical Disc Replacement Revision: A failed artificial disc may be replaced with a new device or converted to a fusion, depending on the condition of the segment.
    
  • Posterior Cervical Fusion: This approach accesses the spine from the back to provide added stabilization or to correct incomplete or misaligned fusion.
    
  • Laminectomy Or Laminoplasty: These procedures relieve pressure on spinal nerves by removing or reshaping parts of the vertebrae.
    
  • Foraminotomy: This surgery enlarges the space where nerve roots exit the spine, potentially reducing compression and improving nerve function.
    
  • Hardware Removal Or Replacement: If spinal hardware causes discomfort, shifting, or instability, it may be removed or replaced to restore alignment and reduce symptoms.

Is Surgery The Best Solution For Post-Fusion Neck Pain? 

Surgery is not the only option when neck pain continues after cervical fusion. In many cases, less invasive, non-surgical treatments may help address symptoms by targeting the underlying cause. While revision procedures may be appropriate for select individuals, physicians typically recommend conservative approaches first.

A previous fusion does not automatically require additional surgery. Image-guided procedures using platelet-rich plasma (PRP) or the body’s own bone marrow concentrate (BMC), prepared using Regenexx lab processes, may help reduce inflammation and support adjacent segment function. 

These procedures may help promote stability and relieve symptoms without removing more tissue or fusing additional vertebrae.

How Regenexx Uses The Body’s Own Healing Agents To Reduce Post-Surgical Pain

Regenexx offers non-surgical options for managing chronic pain that may persist after cervical fusion. These procedures use the body’s own healing processes to help reduce inflammation, support tissue function, and improve joint stability, without removing additional bone or implanting hardware.

Physicians in the licensed Regenexx network use advanced image-guided techniques to deliver precise injections of PRP or BMC, prepared using Regenexx lab processes. Physicians may direct injections to affected areas such as adjacent spinal segments, irritated facet joints, or inflamed nerves contributing to post-surgical symptoms.

By preserving the spinal structure and avoiding additional surgery, procedures using Regenexx injectates are designed to support more natural movement, reduce discomfort, and slow the progression of joint stress in surrounding areas.

Explore Non-Surgical Approaches For Addressing Discomfort After Surgery

Persistent pain following cervical fusion does not always require additional surgery. Identifying potential causes, such as adjacent segment stress, non-union, or nerve irritation—can help guide targeted treatment. Early evaluation may reduce the risk of long-term complications and support a better recovery trajectory.

Regenexx offers image-guided procedures using orthobiologic injections prepared through proprietary lab protocols. These non-surgical options are designed to help manage post-surgical symptoms while preserving spinal mobility. Exploring conservative care may provide a way to reduce pain and support function over time—without the need for additional spinal fusion.

References:

1. Huang X, Cai Y, Chen K, Ren Q, Huang B, Wan G, Wang Y, Lin J, Zhao J. Risk factors and treatment strategies for adjacent segment disease following spinal fusion (Review). Mol Med Rep. 2025 Feb;31(2):33. doi: 10.3892/mmr.2024.13398. Epub 2024 Nov 22. PMID: 39575466; PMCID: PMC11605282.

Medically Reviewed By:

Dr. Chaz Fausel, MD

Dr. Chaz Fausel is a Denver-based interventional orthopedics specialist and Regenexx educator, trained at Emory and the Centeno-Schultz Clinic.