About Cervical Spinal Fusion
Typically, the portion of the brain known as the cerebellum is housed in the lower back section of the skull. With Chiari malformation, however, defects in the skull cause the base of the cerebellum to extend down into the spinal canal, potentially putting pressure on both the brain and the spinal cord.
In some cases, the Chiari malformation is part of a complex of additional bone or connective tissue problems in the region of where the skull and spine interface (craniocervical abnormalities) creating instability that can cause brainstem compression. In these rare situations, the decompressive surgeries typically used to provide additional room for the cerebellum may be inadequate to prevent ongoing damage and relieve symptoms.
Spinal fusion is a surgical procedure that can be performed in conjunction with decompression surgery to help permanently stabilize the spine. During spinal fusion, the skull and vertebrae in the neck are joined (“fused”) together in such a way that they heal into a single bone.
Goal of Cervical Spinal Fusion
Individuals with Chiari malformation may experience dizziness, weakness, numbness, headaches and neck aches. Unfortunately, if instability is also present, attempts to relieve pressure on the brain and spinal canal through posterior fossa decompression surgery alone is unlikely to provide relief and may actually make symptoms worse.
The goal of spinal fusion surgery is to reinforce the spine and help protect the underlying spinal cord from further damage, while also hopefully leading to a reduction in symptoms.
How Cervical Spinal Fusion Is Performed
Spinal fusion is performed under general anesthesia. To allow access to the back of the neck, you will be face down during the procedure and your head will be carefully secured in a special positioning device.
Once fully sedated, the surgeon will make a vertical incision at the top of the spine, just below the skull. The surgeon uses CT and/or imaging guided techniques to carefully guide specialized permanent instrumentation into the appropriate bones that are then linked, permanently connecting the bones together.
Bone fusion material is then placed directly on the surgically fused region to encourage growth as a single unit. Once any additional procedures necessary to relieve pressure on the brain and spinal canal (such as a laminectomy or craniectomy) are completed and decompression is confirmed, the incisions are closed with sutures.
As with any surgical procedure, some soreness is normal during recovery, and pain medication is typically administered to manage the discomfort.
Most patients are able to be up and walking within a few hours of surgery. Following a 2-4 day stay at the hospital for monitoring, you should expect to continue the recovery process at home over the next several weeks. A neck brace is often prescribed to help limit range of motion and protect the neck from rapid or extreme movements. You should take care to avoid any activities, including driving and sports, that might put stress on your neck during the first six weeks post-surgery. You should also avoid lifting heavy weights during this initial recovery period.
While some improvement in symptoms may be apparent soon after the procedure, gradual improvement may continue for up to a year. After appropriate monitoring by your surgeon, physical therapy will likely be recommended to help with range of motion for the neck, although some loss of range of motion is expected with any fusion procedure.
Why Choose Neurosurgeons of New Jersey
Deciding to undergo surgical treatment for Chiari malformation with craniocervical abnormalities can be stressful. Neurosurgeons of New Jersey is committed to making the process as comfortable as possible through an emphasis on communication, cutting-edge technology and truly patient-focused care.
We are one of the largest sub-specialized practices in the tri-state area, and our surgeons have extensive experience in the highly specialized techniques required to successfully treat Chiari malformation patients.
Throughout your interactions with Neurosurgeons of New Jersey, you can expect to be treated with the kind of care and professionalism that has earned us a reputation as one of the Northeast’s premiere neurosurgery centers.