While it seems common sense that all the parts of our spine are connected, because of orthopedic hyperspecialization, most patients believe that their necks and their backs are separate areas. After all, they have different names. Adding to the long list of neck fusion side effects, a new study shows just how wrong they are by recording changes in the low back and pelvis after a surgeon fuses the neck!
One of two stupid things we as medical doctors did regarding the connected body was to allow orthopedic hyperspecialization. We now have the foot and ankle specialist, the knee expert, the hip guru, and the spine guy. Why was this dumb? Because the body is one connected machine, and this sends the message to patients that it’s not connected. So it’s not hard to see why patients can’t make the leap between their neck and their shoulder or their neck and their back.
The second biggest bad idea in medicine with regard to connectivity is how we name things. The fact that we have different names for the neck and the back also gives the same message that these are different things. Instead, our naming should have been something like spine-cervical area and spine-lumbar area just to drive home the point that there’s a spine that has parts that are connected but designed to do different things.
Your spine is one machine from its top to the bottom. The neck is connected to the upper back, which is connected to the lower back, which is connected to the pelvis. What happens in one part of it impacts all other parts. So if your neck curve isn’t right, it impacts your low back, which impacts your pelvis. If this is hard to believe, then let’s look at a new study that painfully proves the point.
A neck fusion is where the doctor uses bolts, screws, and plates to make one part of the spine solid. The discs that normally allow motion are removed, and bone growth is promoted at that spot either chemically or through the addition of metal cages. Suffice it to say that this part of the spine no longer moves normally. However, while we’ve seen many neck fusion side effects, what we haven’t been able to prove is that if it’s fused in anything but the perfect anatomic position, then this may impact other areas.
The authors of the new study observed 48 patients who had undergone an ACDF surgery (a type of neck fusion from the front) with whole spine X-rays at 1,3,6, and 12 months after surgery. They noted that changes in the neck curve from surgery impacted the angles of the tailbone and pelvis! So messing with one end of the spine impacted the other end.
I drew a little diagram above that demonstrates how this works. The fact that the low back now has less of a curve after neck surgery means that the discs there will take on more body weight. This can lead to eventual low-back-disc failures, like bulges, degeneration, and herniations. On the other hand, if you have too much curve, it may be possible to correct that through the neck? Not sure that’s a smart idea, but you can read between the lines of the research to see that that’s where the spine-surgeon authors want to head.
First, make sure there are no other options other than surgery. We see patients every day who have been told they need a neck fusion, but by using advanced regenerative medicine and interventional orthopedics, we’re able to help them avoid this invasive fate. Second, if you absolutely need a neck fusion, then make sure the surgeon has the ability to ensure you get fused into a normal curve. While some surgeons now pay attention to this, most don’t. If the surgeon won’t have this discussion, find a new doctor!
The upshot? I have seen countless patients who have developed back pain after having their neck operated on. While we know of a few mechanisms that can explain that link, this newest of the neck fusion side effects makes all kinds of sense. It’s all connected, folks!
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About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…