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Levels of fusion |
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Another controversy includes how many levels should be fused at the time of surgery: |
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This is especially true in patients who are having an anterior cervical discectomy
and fusion in the presence of multiple abnormal discs. Some surgeons prefer fusing
all disc levels that look bad, whereas in most cases only one level will have herniated
and be symptomatic. The thought is that if another level is bad it will probably
need to be fused in the future. The dilemma with fusing increasing numbers of levels
is that it places more pressure and strain on the unfused segments. On the other
hand, trying to ‘cherry pick’ the one or two bad levels risks inadequately treating
the patient’s problem. Other surgeons feel that fusing only the clearly pathological
level(s) (e.g. the one with the herniation that is causing the arm pain) is desirable
as it maintains more of the normal motion and biomechanics of the neck. |
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There is no definitive answer as to which philosophy is better, and each individual
patient is a little different. As a patient, the best way to consider this factor
is to realize that the number of levels fused is a balancing act. Saving motion
segments is desirable but comes at the cost of either under-treating the original
problem or possibly needing another level fused in the near future |
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The chance that another level will need to be fused in the future is difficult to
quantify. Some studies have suggested that the rate of adjacent disc breakdown requiring
further surgery is between 10-25% over ten years. More data are required before
we will be able to definitely answer this controversy. |
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