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

Complex conditions affecting the cervical spine may sometimes require surgery involving multiple levels of the neck. Multilevel cervical fusion, also known as arthrodesis, is a specialized procedure used to treat severe spinal problems caused by degeneration, trauma, previous surgeries, deformity, instability, or tumors. These conditions can lead to spinal cord or nerve compression, pain, and loss of function.

At Complete Orthopedics, our experienced spine surgeons use advanced surgical techniques to restore spinal stability, improve alignment, and protect neurological function.

This page explains when multilevel cervical fusion may be recommended, how the procedure is performed, and what patients can expect throughout the evaluation, treatment, and recovery process.

How Common It Is and Who Gets It

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

• 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

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 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

• 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

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

• 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

• 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

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.

Cost Information

This procedure under CPT code 22551 at Complete Orthopedics is covered by Medicare and most major insurance carriers (Aetna, Anthem BCBS, Cigna, Empire BCBS, UnitedHealthcare), as well as most workers’ compensation and no-fault insurance plans. Your out-of-pocket cost depends on your specific plan, deductible, and the medical necessity criteria that apply to your case.

Call our billing team at (631) 981-2663 before scheduling to verify your coverage and discuss expected out-of-pocket costs. For the full list of carriers we accept and patient billing protections, see our Insurance Information page.

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.