4- And 5-Level Anterior Fusions Of The Cervical Spine

Performing arthrodesis on four or five levels in the cervical spine is a rare procedure, even in high-volume spine centers. Multilevel discectomies and corpectomies are typically needed for treating degenerative conditions, post-traumatic or post-surgical deformities, and instability from neoplasms. The prevalence of diffuse spinal canal constriction and kyphosis is high in such cases, and anterior approaches are often the most viable surgical alternatives. Restoring cervical lordosis can improve neurological recovery and clinical outcomes.

How Common It Is and Who Gets It? (Epidemiology)

This type of surgery is not common but is essential for patients suffering from severe degenerative conditions, especially osteoarthritis, rheumatoid arthritis, or spondylolisthesis, and spinal stenosis. It’s generally considered for those who have failed other conservative treatments such as physical therapy, medications, or injections.

Why It Happens – Causes (Etiology and Pathophysiology)

• Degenerative Conditions: Wear and tear, particularly in osteoarthritis, leads to the breakdown of cartilage in the cervical spine.

• Trauma: Previous injury or surgery can result in deformities or instability.

• Neoplastic Disorders: Cancers or tumors affecting the cervical spine may lead to deformity or nerve compression.

• Spinal Deformities: Congenital abnormalities in the development of the spine may also necessitate such surgery.

How the Body Part Normally Works? (Relevant Anatomy)

The cervical spine is made up of seven vertebrae (C1–C7) with intervertebral discs between them. The discs serve as cushions, and the vertebrae are connected by ligaments, muscles, and tendons. The cervical spine allows for head movements like flexion, extension, and rotation, while also protecting the spinal cord and nerves. When degeneration or injury occurs, it disrupts the structure, causing pain, instability, and possibly nerve compression.

What You Might Feel – Symptoms (Clinical Presentation)

Symptoms that often prompt 4- and 5-level anterior fusions include:

• Severe neck pain that limits mobility.

• Radiating pain or numbness in the arms and hands, indicating nerve compression.

• Muscle weakness or difficulty performing everyday tasks such as holding objects or turning the head.

• Neck stiffness and restricted range of motion.

• Postural changes or visible deformities in the spine.

How Doctors Find the Problem? (Diagnosis and Imaging)

• Physical Examination: Assesses neck mobility, alignment, and nerve function.

• X-rays: Determine vertebral alignment and degeneration of discs.

• MRI: Detailed imaging to visualize disc herniation, spinal stenosis, and nerve compression.

• CT Scans: Provide a clearer view of bone structures and are used in surgical planning.

• Discography: Identifies pain-producing discs by injecting a contrast dye.

Procedure Types or Techniques (Classification)

The main techniques used are:

• Anterior Cervical Discectomy and Fusion (ACDF): Removes herniated or degenerated discs and fuses the vertebrae using bone grafts.

• Corpectomy: Removal of a vertebral body along with the discs above and below it, followed by fusion to stabilize the spine.

• Hybrid Techniques: A combination of discectomies and corpectomies, which is less invasive and preserves bone integrity.

Other Problems That Can Feel Similar (Differential Diagnosis)

• Cervical Radiculopathy: Nerve root compression causing pain, numbness, or weakness.

• Cervical Myelopathy: Spinal cord compression leading to more severe neurological symptoms.

• Facet Joint Arthritis: Pain from degenerative changes in the small joints between vertebrae.

Treatment Options

Conservative treatments should be tried first, including:

• Physical Therapy: Strengthening the muscles supporting the spine.

• Medications: NSAIDs or steroids for inflammation.

• Injections: Epidural steroid injections or nerve blocks for pain relief.

• Surgery: If conservative treatments fail, surgery such as ACDF or corpectomy may be necessary to remove the damaged discs and fuse the vertebrae.

Recovery and What to Expect After Surgery

• Hospital Stay: Usually 1-2 days post-surgery.

• Pain Management: Patients are given medication to control pain and prevent muscle spasms.

• Physical Therapy: Starts soon after surgery to regain neck mobility and strength.

• Fusion Process: Bone healing takes time, usually about 3–6 months for the fusion to fully solidify.

• Lifestyle Adjustments: Patients are advised to avoid heavy lifting and twisting motions during recovery.

Possible Risks or Side Effects (Complications)

• Infection: Though rare, it can occur at the surgical site.

• Nerve Injury: There is a risk of damaging nerves during surgery, leading to weakness or numbness.

• Dysphagia (Difficulty Swallowing): A common complication due to the proximity of the surgery to the esophagus.

• Cage Subsidence: The implant may shift or collapse over time, requiring revision surgery.

• Pseudoarthrosis: Failure of the vertebrae to fuse together properly.

Long-Term Outlook (Prognosis)

Most patients experience significant relief from pain and improved quality of life after 4- and 5-level anterior cervical fusions. The fusion rates for these procedures are generally high, around 95%. Patients report increased mobility and a return to daily activities, although long-term success can depend on factors such as age, bone quality, and adherence to rehabilitation protocols.

Out-of-Pocket Costs

Medicare

CPT Code 22551 – Anterior Cervical Discectomy and Fusion (ACDF): $417.50

Under Medicare, 80% of the approved amount for this procedure is covered after your annual deductible has been met. The remaining 20% is typically the patient’s responsibility. Supplemental insurance plans—such as Medigap, AARP, or Blue Cross Blue Shield—generally cover this 20%, meaning most patients will have little to no out-of-pocket expenses for Medicare-approved ACDF surgeries. These supplemental plans coordinate with Medicare to provide comprehensive coverage for cervical spine fusion procedures.

If you have secondary insurance—such as Employer-Based plans, TRICARE, or Veterans Health Administration (VHA)—it acts as a secondary payer after Medicare has processed the claim. Once your deductible is satisfied, these secondary plans may cover any remaining balance, including coinsurance. Secondary plans typically have a modest deductible, generally ranging from $100 to $300, depending on your policy and network status.

Workers’ Compensation
If your cervical spine condition or injury requiring fusion resulted from a work-related injury, Workers’ Compensation will cover all related medical and surgical expenses, including the fusion procedure and rehabilitation. You will not have any out-of-pocket costs under an accepted Workers’ Compensation claim.

No-Fault Insurance
If your cervical spine injury is the result of a motor vehicle accident, No-Fault Insurance will pay for all surgical and hospital expenses related to your anterior cervical fusion. The only potential out-of-pocket expense may be a small deductible depending on your specific insurance policy terms.

Example
Sarah, a 62-year-old patient with degenerative cervical disc disease, required a 4-level anterior cervical discectomy and fusion (CPT 22551) for neck pain and weakness. Her estimated Medicare out-of-pocket cost was $417.50. Since she had supplemental insurance through Blue Cross Blue Shield, the remaining 20% that Medicare did not cover was fully paid, leaving her with no out-of-pocket expense for her surgery.

Frequently Asked Questions (FAQ)

How long will recovery take?
Recovery typically takes 3-6 months, depending on the individual and the extent of the surgery.

Will I need additional surgeries later?
The goal of the surgery is long-term relief, but in rare cases, adjacent segment degeneration may require further treatment.

Can I return to work immediately after surgery?
Most patients return to light work within 6-8 weeks. Jobs that require heavy lifting may require up to 3-6 months.

Summary and Takeaway

4- and 5-level anterior cervical fusions provide significant benefits in terms of pain relief and spine stabilization for patients with severe cervical degenerative conditions. Both ACDF and corpectomy techniques offer strong fusion rates and successful outcomes when performed by skilled surgeons. Hybrid approaches may offer additional advantages in certain cases, and a combination of preoperative planning, careful surgical technique, and postoperative rehabilitation can optimize results.

Who Performs This Surgery? (Specialists and Team Involved)

This surgery is performed by spine surgeons specializing in cervical spine surgery. The surgical team includes anesthesiologists, surgical assistants, and radiologists for intraoperative imaging.

When to See a Specialist?

If you experience persistent neck pain, numbness, or weakness in the arms or legs, consult a spine surgeon to assess whether cervical fusion surgery is appropriate.

When to Go to the Emergency Room?

Seek immediate care if you experience:

• Sudden loss of strength in the arms or legs.

• Difficulty swallowing or breathing difficulties.

• Severe pain or complications that interfere with normal functioning.

What Recovery Really Looks Like?

Patients generally walk within a day of surgery, with gradual improvement over the next several months. Physical therapy and follow-up visits will be important for monitoring progress and ensuring proper fusion.

What Happens If You Delay Surgery?

Delaying surgery can lead to worsening symptoms and permanent neurological damage. Early intervention with decompression and fusion provides the best chance for recovery.

How to Prevent Recurrence or Failure?

• Avoid heavy lifting and follow postoperative activity restrictions.

• Engage in physical therapy to strengthen surrounding muscles.

• Maintain a healthy weight to reduce stress on the spine.

Nutrition and Bone or Joint Health

• Calcium and Vitamin D intake are crucial for bone health and fusion.

• Eat a balanced diet to support healing and overall health.

Activity and Lifestyle Modifications

• Low-impact exercises like swimming or walking are ideal for maintaining mobility.

• Avoid high-impact activities that could strain the spine.

• Maintain good posture and practice body mechanics to protect the cervical spine.

Do you have more questions?