Non-fusion Surgeries of Lower Cervical Spine

Non-fusion surgeries for the lower cervical spine are becoming increasingly popular due to their ability to treat spinal conditions while preserving natural motion. These procedures aim to relieve pain and improve function without the need to permanently fuse the vertebrae together, which is a common drawback of traditional spinal fusion surgeries.

At Complete Orthopedics, our experienced surgeons use advanced techniques to evaluate and treat cervical spine conditions.

This page explains what may be recommended, how the procedure is performed, and what patients can expect before, during, and after surgery.

How Common It Is and Who Gets It

Non-fusion surgeries are commonly performed on patients suffering from conditions like degenerative disc disease, cervical radiculopathy, herniated discs, and spondylotic myelopathy, especially in individuals who are experiencing significant pain and neurological symptoms. While spinal fusion has traditionally been used to address these issues, non-fusion surgeries offer a promising alternative, particularly for patients who want to maintain mobility in their spine.

Why It Happens

Conditions that affect the cervical spine can lead to compression of the spinal cord or nerve roots, causing pain, numbness, weakness, and other neurological symptoms. Factors such as aging, wear and tear, or trauma can cause discs to deteriorate, leading to cervical radiculopathy or myelopathy. Non-fusion surgeries aim to alleviate this compression without sacrificing the movement of the spine, preserving overall spinal function and reducing the risk of adjacent segment degeneration, which can occur with spinal fusion.

How the Body Part Normally Works

The cervical spine consists of seven vertebrae (C1 to C7), with intervertebral discs between them. These discs act as cushions, absorbing shock and allowing for movement. Nerves exit the spinal cord through the foramen, small openings between the vertebrae. When these discs degenerate or herniate, they can compress the nerve roots, leading to pain and other symptoms. Non-fusion surgeries aim to relieve this pressure while maintaining spinal mobility.

What You Might Feel

Patients with cervical spine conditions requiring non-fusion surgeries often experience:

• Neck Pain: Often accompanied by radiating pain down the arms or shoulders.
• Numbness and Tingling: In the arms, hands, or fingers, indicating nerve compression.
• Weakness: Difficulty lifting or controlling muscles in the arms or hands.
• Loss of Balance: Due to neurological involvement from spinal cord compression.
• Limited Range of Motion: Stiffness in the neck, making it hard to turn or tilt the head.

How Doctors Find the Problem

Diagnosis is typically made through:

• X-rays: To assess alignment and detect degenerative changes in the spine.
• MRI: Provides detailed images of soft tissues, including nerves and discs, to assess for nerve compression or disc herniation.
• CT scans: Useful for evaluating bone spurs and other bony structures in the spine.
• Electromyography (EMG): To test the electrical activity of muscles and determine if nerve compression is affecting function.

The Limitations of Spinal Fusion

Spinal fusion has long been the go-to surgical treatment for severe cervical spine issues such as herniated discs, degenerative disc disease, and spinal instability. The procedure involves joining two or more vertebrae together to eliminate movement between them, which can help to reduce pain and prevent further damage. However, spinal fusion has several limitations:

Loss of Mobility: Fusion eliminates movement at the operated level, which can significantly reduce the overall flexibility and range of motion of the spine​

Adjacent Segment Disease: By immobilizing a segment of the spine, the procedure increases stress on the adjacent segments, potentially leading to accelerated degeneration and the need for additional surgeries in the future​ 

Extended Recovery Time: Recovery from spinal fusion can be lengthy and challenging, often requiring significant physical therapy and rehabilitation​ 

Advantages of Non-Fusion Surgeries

Non-fusion surgeries offer several advantages over traditional spinal fusion:

Preservation of Motion: These procedures are designed to maintain the natural movement of the spine, which is crucial for overall spinal health and functionality​ 

Reduced Risk of Adjacent Segment Disease: By preserving movement, non-fusion surgeries help to distribute mechanical stress more evenly across the spine, reducing the risk of adjacent segment degeneration​ 

Faster Recovery: Patients often experience quicker recovery times and less post-operative discomfort compared to traditional fusion surgeries​ 

Classification

Non-fusion surgeries for the cervical spine can be classified into the following techniques:

• Artificial Disc Replacement (ADR): Replacing a degenerated or damaged cervical disc with an artificial disc to maintain motion and relieve nerve compression.
• Cervical Disc Arthroplasty: Similar to ADR, it replaces a damaged cervical disc with an artificial one to preserve spinal motion.
• Posterior Cervical Laminoplasty: Expanding the spinal canal by reshaping or repositioning the lamina to relieve pressure on the spinal cord or nerve roots while maintaining flexibility in the spine.

Click on Cervical Laminoplasty for procedure and cost information.

Advances in Non-Fusion Technology

Recent advancements in medical technology have led to the development of more sophisticated implants and techniques, enhancing the effectiveness and outcomes of non-fusion surgeries.

Biomimetic Artificial Discs

1. Innovation: Newer artificial discs are designed to closely mimic the natural structure and function of human discs, enhancing compatibility and performance. These biomimetic discs aim to replicate the natural elasticity, load-bearing capacity, and range of motion of healthy discs​ 
2. Biomechanical Analysis: Studies have demonstrated that these advanced discs provide superior range of motion and stress distribution compared to earlier models, making them a promising option for non-fusion cervical spine surgery​ 

Hybrid Surgery Approaches

1. Combination Techniques: Some patients benefit from a combination of fusion and non-fusion techniques, known as hybrid surgeries. For example, one level of the spine may be fused while another level is treated with an artificial disc. This approach aims to balance stability with mobility, optimizing patient outcomes​ 
2. Benefits: Hybrid surgeries can provide the necessary stability for severely damaged segments while preserving motion at adjacent levels, reducing the overall impact on spinal biomechanics​ 

Minimally Invasive Techniques

• Innovation: Advances in surgical technology have made it possible to perform many non-fusion procedures using minimally invasive techniques. These approaches involve smaller incisions, less tissue damage, and reduced blood loss compared to traditional open surgeries​ 
• Benefits: Minimally invasive techniques often result in faster recovery times, less post-operative pain, and lower risks of complications, making them an attractive option for many patients​ 

Treatment Options

• Non-Surgical Care: Conservative treatments such as physical therapy, pain management, and injections are typically the first line of treatment.
• Surgical Care: If conservative treatments fail, non-fusion surgeries like ADR, cervical disc arthroplasty, or posterior cervical laminoplasty may be considered to relieve nerve compression and preserve spinal mobility.

Recovery and What to Expect After Treatment

• Hospital Stay: Many patients undergoing non-fusion surgeries can go home the same day or stay for one night.
• Pain Management: Post-surgical pain is generally less intense than that associated with spinal fusion and is managed with medications.
• Physical Therapy: Rehabilitation is important for restoring strength and flexibility in the neck and upper body.
• Activity Restrictions: Patients are usually advised to avoid heavy lifting or strenuous activities during the early recovery phase.

Full recovery typically takes a few weeks to several months, depending on the individual’s health and the extent of the surgery.

Possible Risks or Side Effects

As with any surgery, there are risks, including:

• Infection: Risk of infection at the surgical site, although this is rare.
• Nerve Injury: Injury to the spinal cord or nerve roots, which could worsen symptoms or cause new neurological deficits.
• Implant Failure: The artificial disc or other implants used may shift or fail.
• Adjacent Segment Disease: While non-fusion surgeries reduce the risk, adjacent segments can still degenerate over time.
• Spinal Instability: In rare cases, the spine may not heal properly or become unstable, leading to further complications.

Long-Term Outlook

The long-term outlook for patients who undergo non-fusion cervical spine surgeries is generally positive. Many patients experience significant relief from pain and improved function, particularly with procedures like ADR and cervical disc arthroplasty. The ability to maintain spinal movement reduces the likelihood of adjacent segment degeneration, and patients typically recover more quickly than those who undergo spinal fusion.

Out-of-Pocket Cost

These procedures under CPT codes 22856, 63050, 22552, 22856, 63050, 61783, and 76000 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

Non-fusion surgeries for the cervical spine, such as ADR and cervical disc arthroplasty, offer significant advantages over traditional spinal fusion. They preserve spinal motion, reduce the risk of adjacent segment disease, and allow for faster recovery. These procedures are particularly beneficial for patients suffering from cervical radiculopathy or degenerative disc disease, where maintaining spinal flexibility is essential for long-term spinal health.