Version July 2025
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What is anterior cervical spinal fusion? —
Spinal fusion is surgery to permanently join 2 or more bones together in the spine (figure 1). Then, there is no movement between those bones anymore.
"Cervical" means the upper part of the spine (in the neck) (figure 2). "Anterior" means the doctor does the surgery from the front of the neck instead of the back.
The back and neck are made up of (figure 3):
●Vertebrae – These are the bones of the spine. Each has a hole in the center. The vertebrae are stacked on top of each other, and the holes form a hollow tube called the "spinal canal." The spinal cord passes through this tube and is protected by the vertebrae.
●Discs – Rubbery discs sit in between each of the vertebrae. They add cushion and allow movement.
●Spinal cord and nerves – The spinal cord is the bundle of nerves that connects the brain to the rest of the body. It runs through the vertebrae. Nerves branch from the spinal cord and pass in between the vertebrae. From there, they connect to the arms, legs, and organs.
●Muscles, tendons, and ligaments – These support the vertebrae and are used to move the head and neck. They are also called the "soft tissues" of the neck and back.
Problems with any of these can make the back or neck unstable. Or they can cause pain, numbness, or weakness.
Why might I need cervical spinal fusion? —
Doctors can do cervical spinal fusion to treat long-term pain and disability from nerve injury. People who have a spinal fusion have often tried physical therapy, medicines, and other treatments.
Examples of conditions that might be treated with spinal fusion include:
●Spinal stenosis – This is when the spinal canal (the space around the spinal cord) becomes too narrow. It can be caused by disc problems, bone spurs, or tumors. It can cause the spinal cord or nerves to get pinched.
●Herniated disc – This is a disc that breaks open and bulges out, causing spinal cord or nerve root compression.
●Slipped vertebra – This is when 1 vertebra moves forward, out of line with the rest of the vertebrae. This can cause spinal or nerve root compression.
●A spinal injury or broken bone
How is anterior spinal fusion done? —
The procedure is done as open surgery. The doctor makes a cut ("incision") in the skin on the front of the neck, just to the side of the trachea (windpipe). This lets them see directly inside the body to do the surgery.
They might remove bone or tissue that is pressing on the spinal cord or nerves. Then, they will do a "bone graft." They might also use screws, cages, or plates to hold the bones in place (figure 1).
How do I prepare for anterior cervical spinal fusion? —
The doctor or nurse will tell you if you need to do anything special to prepare.
Before the procedure, your doctor will do an exam. They might send you to get tests, such as:
●X-rays, CT or MRI scans, or other imaging tests – These create pictures of the inside of the body.
●Lab tests
Your doctor will also ask about your "health history." This involves asking about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:
●Any medicines you are taking – This includes prescription and "over-the-counter" medicines, plus any herbal supplements. It helps to write down and bring a list of your medicines, or bring a bag with all your medicines with you.
●Any allergies you have
●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.
You will also get information about:
●Eating and drinking before the procedure – You will likely need to "fast" before surgery. This means not eating or drinking anything for a period of time. You might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure.
●Lowering the risk of infection – You might need to trim (not shave) your body hair before the procedure. You might also need to wash the area with a special soap.
●What help you will need when you go home – For example, you might need someone else to bring you home or stay with you for some time while you recover.
Ask the doctor or nurse if you have questions or if there is anything you do not understand.
What happens during anterior cervical spinal fusion? —
When it is time for the procedure:
●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.
●You will get general anesthesia medicines. This is to make sure you do not feel pain during the procedure. It makes you unconscious so you can't feel, see, or hear anything during the procedure. You might get a breathing tube to help you breathe.
●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.
●The doctor will make an incision in the skin of your neck. They will gently move the muscles and tissues, so they can see your spine.
●They might remove bone or tissue that is pressing on your spine or nerves.
●They will use a bone graft to join, or "fuse," the bones together. The bone graft helps with bone healing. It might be:
•Taken from another part of your body, like your hip
•Made from specially prepared bone from a donor
•Made of artificial bone
●After the bone graft is in place, the doctor might use screws, cages, or plates to hold the bones in place.
●They might place a drain tube in your back close to the incision. This will get rid of any extra fluid or blood around the incision. The drain tube is hooked to a collection bulb. The fluid is emptied from the bulb each day until the drain is removed.
●The doctor will close your incision and cover it with clean bandages.
●The procedure usually takes 1 to 3 hours.
What happens after anterior cervical spinal fusion? —
You will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. You might be able to go home the same day. Or you might stay in the hospital for a day or so.
As you recover:
●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.
●You might have a sore throat or trouble swallowing from the breathing tube. This usually gets better quickly. For a few people, the difficulty swallowing can last for a few weeks or longer.
●The staff will help you get out of bed and start moving around when you are ready.
●You might have to wear a neck brace to protect your neck.
●You will get medicine to help with pain, if needed. You might need other medicines, too.
●When you are ready to eat, you might start with things that are soft and easy to swallow. Then, you can start eating as you are able. You might feel better if you start with bland foods.
What are the risks of spinal fusion? —
Your doctor will talk to you about all the possible risks, and answer your questions. Possible risks include:
●Bleeding
●Throat, spinal cord, or nerve damage
●Spinal fluid leakage
●Stroke
●Trouble swallowing, or voice changes
●Problems with bowel or bladder function
●Bones not fusing
Spinal fusion can help reduce pain and improve symptoms for some people. But others develop problems after surgery. Possible problems include:
●Stiffness
●Symptoms not going away
●Needing more surgery in the future
What else should I know? —
Before you go home from the hospital, make sure you know what problems to look out for and when to call the doctor. Make sure you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.
Patient education: Anterior cervical spinal fusion – Discharge instructions (The Basics)
Patient education: Posterior cervical spinal fusion (The Basics)
Patient education: Thoracic or lumbar spinal fusion (The Basics)
Patient education: Cervical spinal stenosis (The Basics)
Patient education: Herniated disc (The Basics)
Patient education: Scoliosis (The Basics)
Patient education: Ankylosing spondylitis (The Basics)
Patient education: Vertebral compression fracture (The Basics)
Patient education: Axial spondyloarthritis, including ankylosing spondylitis (Beyond the Basics)
