1. What is anterior cervical fusion?
   An anterior cervical fusion is surgery designed to take two vertebrae in your neck and “weld” them together with a piece of bone. The bone is taken from your pelvis or from a cadaver (allograft bone) and is placed between the vertebrae in the front (anterior) part of your cervical spine. The bone is placed in the area of the spine that is degenerated, and the disk is completely removed. It takes the body approximately 4 months to fuse these together solidly.
   
   
2. What are the details of the operation?
   The procedure takes 1 ½- 2 hours to perform. An incision is made across the front part of your neck. The incision goes past your esophagus and trachea, and your spine is directly under this area. After surgery, you are usually somewhat hoarse, and there is some difficulty involved in swallowing for 3 to 4 days. This is quite common, and usually resolves completely. You can get up and around the day of surgery and will be in a soft collar.
   
   
3. What is the postoperative course like?
   A soft or rigid collar may be used for immobilization for 6 weeks after the surgery. After that, no collar is needed. Usually at 4 months, we can tell by x-ray if the fusion is healed.
   
   
4. What is the success rate?
   If the disease is localized to one level of your neck, there is approximately a 80% chance you will benefit from the operation. There is a 20% chance that the surgery will do you a little, if any, good. The chance of benefit for a two-level fusion drops to 60%, and for a three-level fusion, to 50%. There is a chance that the symptoms may be worse; however, the chances are slight.
   
   The goal of the surgery is to give you enough pain relief to fell that the surgery was worthwhile, but rarely do we attain absolutely complete pain relief. We believe that this is because there are so many pain-producing areas in the cervical spine. It is our feeling that with a cervical fusion we are attempting to eliminate the greatest source of pain.
   
   
5. What are the risks of surgery?
   There are several risks to the operation of which you should be aware. One of these is that the bone placed between your vertebrae might not fuse and there would be a nonunion of this area. However, we find that the fibrous tissue and scar tissue that form are usually enough to take care of the pain relief. Occasionally we will go back in and operate for a nonunion of the cervical spine, but often we simply have to accept the nonunion and residual pain. Nonunion happens about 15% of the time.
   
   Infection is a complication that can occur 1% to 3% of the time. This may require further surgery, and/ or antibiotics. Another small risk is that of injuring the nerve that controls the vocal cords. This is almost always temporary, but may take up to six months to resolve. permanently damaging the vocal cords so that you may be permanently hoarse.[JG1]
   
   Other potential complications are damage to the esophagus, spinal cord, nerve roots and arteries in the neck area. These are potentially very serious complications, which may lead to severe neurological complications, including quadriplegia or a fatal outcome. However, the incidence is extremely low.
   
   There are other complications, such as anesthesia problems and allergic reactions to medications. We do our best to minimize these complications, but they occasionally occur.
   
   Our overall advice for this type of surgery is the same for any other spine surgery, which is to live with the pain you are experiencing if you possibly can. The reason for undergoing the operation is that the pain is making life so uncomfortable that you are willing to undertake the risks of the operation and willing to accept the chance of a result that is less that 100% successful.
   
   It is extremely difficult for us to tell you how much pain you are experiencing. Therefore, the decision of whether or not to have surgery is completely up to you when we are talking about pain. Therefore, it must be emphasized that when an operation is being considered for pain relief, the decision is 100% up to you.
   
   

Summary
This letter is intended to answer questions, but do not hesitate to ask us as many questions as needed to get a clear picture of the procedure and options available.