Neck Surgery

Cervical Fusion of the C1-C2 Vertebrae by Dr. Joel Franck

What is Cervical Fusion?

Dr. Joel Franck specializes in a neck surgery known as “cervical fusion” and has developed an innovative, highly effective, method of C1-C2 fusion, requiring only a brief recovery at the surgery center then a premium hotel stay with 23 hour nursing care immediately post-op.

Patients who may benefit from surgical treatment of neck injuries have suffered from whiplash related symptoms.

 

What are the steps to my neck surgery?

When you decide on surgery, the plan would be as follows:

Before Surgery:

It is best to fly in on the Weds before surgery. If you need an updated Cervical DMX,  it can be done locally at NuBest in Tampa or St. Pete. The upright positional Cervical MRI that is very useful in analyzing and planning your surgery should not be more than four months old.

 
Thank you from the bottom of my heart. My life has changed so much since my surgery…For so long it seemed my nightmare was never going to end…I feel like a completely different person…I can’t begin to tell you how thankful and blessed I am to have you as my surgeon…” A.G., Alabama, May, 2014

We can order an updated scan, if necessary, at Rose Radiology in Tampa, FL. If significant herniated Cervical discs are found when we review the MRI scan and DMX,  Dr. Franck may recommend that he perform an Anterior Cervical Discectomy and Fusion, prior or after C1-C2 fusion.

Please note it is important that you DO NOT take any medications that could thin your blood and delay clotting for two weeks prior to surgery – which include aspirin, anti-inflammatories such as Aleve or Motrin or Ibuprofen, or Goody Powders, etc. If you are on medications such as Plavix, Xarelto, or aspirin prescribed by your Internist or Cardiologist, you MUST discuss the safest timing of  temporarily stopping the drug with your personal physician.

We would see you on that Thursday or Friday for an extended visit lasting between one and one-half to three hours. It is advisable to bring a close friend or relative to accompany you to the visit. We will thoroughly review your history, perform a complete detailed physical exam, and spend a considerable amount of time reviewing your imaging studies and the upcoming surgery.

During Surgery:

At surgery, you will be gently anesthetized for general anesthesia and be monitored closely.

You will be carefully placed face down on the operating table. We will use an ultra hi-tech radar guidance system, called the STEALTH, in combination with an intra-operative CT scanner, called the O-Arm, to target C1-C2.

A small incision will be made at the top of the cervical spine, below your skull, and two small insertion points at the base of your cervical spine.

Using the STEALTH radar system, Two 4 mm diameter titanium small screws will be carefully guided  from the insertion points, by a minimally invasive technique to connect C1 and C2.

Bone fusion material will be directly placed on C1 and C2. Finally,  two square centimeters of bone from the occipital skull base at the top of the spine will be removed if needed, in order to remove the pressure on the base of the brainstem shown on the upright MRI.

The operation will take about four hours start to finish and during surgery I make a point of letting your family know how things are progressing in a timely fashion.

After Surgery:

You will awaken with a cervical collar which you must wear for six weeks. There is a brief recovery period in the post anesthesia care unit. You will be discharged to a Premium hotel with 23/hr nursing care.  Prescriptions for post-op pain medications will be given on the day of surgery.  When you do return home, you can resume fairly normal activities, of course avoiding heavy lifting, climbing, crawling, or overhead work.  Driving is not advised for six weeks as you will be in a cervical collar.

We then check you on Post-op day 1 and two and a half weeks. Subsequent follow up visits with cervical x-rays are then done at six weeks, six months and one year.

It is important you remain in the area for two and a half weeks after surgery.  This is a world class vacation destination spot with some of the most beautiful beaches in the world! Family members will love it, and it is a great place to recuperate.

Thank you for the privilege and honor of being with you in surgery. What you do for patients is truly an art form…” Christopher Oshie DC, Waterside Chiropractic, Panama City Beach, Florida 2014
Neck Surgery - Dr Franck

Dr. Joel Franck performing neck surgery

Stealth-O-Arm

Stealth-O Arm

Lag Screw, Neck Surgery

Lag Screw Size

Lag Screw Placement

More information about the Cervical Spine

Spine Anatomy

SpineYour spinal cord is the lifeline that connects your brain with the outside world. Sensations from the outside world, such as touch, temperature, and vibration, and internal sens such as joint position, muscle tension, and pain, are transmitted up the spinal cord to your brain. Your brain controls your body through conscious commands to muscles and reflex controls of vital functions such as breathing, blood pressure, and pulse, transmitted down the spinal cord. All of these functions are mediated through nerve roots, connecting the spinal cord with the body.

The spinal cord is housed in and protected by the spinal column. The spinal column consists of individual elements or building blocks called vertebra. The vertebra, in turn, consists of a vertebral body, oriented towards the front of the body, and two pillars, called pedicles. The pedicles, in turn, support the posterior roof of the vertebra known as the lamina and the spinous process. You can feel the spinous processes by running your hand down your back and neck.

Your vertebra are stacked one on the other, separated by the disc, thus, forming a column. The disc, in turn, consists of a thick circular ligament surrounding a soft latex like core, and it, thus, acts as both a shock absorber between the vertebra and a joint allowing your spinal column to bend.

The vertebra are connected in back through a left and a right facet joint. Thus, each vertebra is connected to the next with the disc in front of the spinal cord and lying between each vertebral body; and the two facet joints in back of the spinal cord.

The most important function of your vertebral spinal column is to protect your spinal cord and nerve roots. Thus, the spinal vertebra stacked one upon the other, separated by your discs, forms a canal in which your spinal cord is located. Your spinal cord is thereby protected during normal functions of living, including bending, rotating, walking, running, and every other function you can imagine. Your individual vertebra are connected by multiple ligaments, running up and down the spine, in front, in the canal, and in the back. The ligaments act to limit the motion of your spine to safe levels and, thereby, protect the spinal cord.

Spine Anatomy - VertebraeNow, your spinal column is divided into groups of vertebra, that are related to each other by their specific functions. For example, your skull, containing your brain and its connection to the spinal cord, the brainstem, is contained in the skull. The bottom/rear part of the skull, the occiput, is connected to the upper spine called the Cervical Spine, located in your neck. The Cervical spine consists of seven vertebra – numbered C1 through C7. In turn, the Cervical spine is connected to the Thoracic spine to which are attached the ribs (surrounding the hearts and lungs), and contains twelve more vertebra – numbered T1 through T12. The Thoracic spine sits on your low back, or the Lumbar spine, which contains five vertebra – numbered L1 – L5. Finally, the spine connects to your pelvis via the Sacrum upon which sit the Lumbar vertebra. Remember that your spinal cord – your lifeline to your body and the outside world runs through and is protected in the spinal canal.

Cervical Spine Anatomy

Now let’s talk more about the Cervical spine. Remember that I said every vertebral body is separated from the next one in the spinal column by the disc. Well that is not strictly true. The two uppermost Cervical vertebra – C1 and C2 – have unique structures that provide specific capabilities to the spine. This website will focus on the complex medical and neurological issues surrounding these two unique vertebra, because of their crucial importance in the overall function of your spine as a whole, and their relationship to injuries of the Cervical spine, specifically including whiplash.

Cervical Spine AnatomyLike most of the other vertebra, C2 has a vertebral body, pedicles, and lamina, allowing it to fit in the design of the spinal column. however, there is no disc between C1 and C2. Instead, there is a process, a peg of sorts, that protrudes upwardly out of the top part of the vertebral body of C2. This peg is known as the Dens or Odontoid. It has a very specific function, which is to act as Axis, about which the body of C1 can rotate. Therefore, the C2 vertebra as a whole is nicknamed “the Axis”.

Now C1 has a very different structure indeed, as compared to all the other vertebra. There is a slender thinned out vertebral body of sorts, called the tubercle, in front. It connects a right and left lateral mass, the inferior portions of which rotate on the lateral masses of C2. In back there is a ringlike lamina, with only a small spinous process. Now, most importantly, the bottom portion of the skull, known as the Occiput, rests on the top portion of the lateral masses of C1. Thus, C1 supports the skull. In an analogy to ancient Greek mythology, C1 is known as the Atlas, in that just as Atlas holds up the earth, C1, our “Atlas” holds up the skull and brain.

The skull-C1 junction is called the Occipital-Cervical junction. It is of crucial importance in injuries to the Cervical spine such as whiplash.

What exactly does the Cervical Spine do?

The Cervical spine protects the Cervical Spinal cord while moving , rotating, twisting, and bending in multiple directions and planes. Each vertebra has a specific function. The lower five vertebra – C3 through C7, can flex, extend, rotate, and bend side-to-side, limited by the disc in front, two facet joints in back, and by the various ligaments present in and around the spine.

On the other hand, the Occiput/Skull is generally limited to flexing (down to 25 degrees) and extending (up to 25 degrees), with limited rotation (to 8 degrees), all by virtue of its connection to C1 via certain ligaments. C1, in turn, can rotate about the Odontoid extension of the C2 Axis, to the tune of about 25 degrees each way with only about eight degrees of flexion and extension. It is crucial here to understand that C1 normally does not laterally slide on C2. Its motion is largely limited to rotation about the Axis, via the stability provided by certain ligaments. If these ligaments are injured then lateral sliding of C1 on C2 occurs which sets off the cascade of post-whiplash migraine headaches and a host of neurological and other symptoms, known as the Whiplash Associated Disorder / Cranial Cervical Syndrome.

So what creates the limits of respective motion of all of these structures? Each vertebra is attached to the next via ligaments – the bungee cords of the vertebral column. I mentioned the anterior and posterior longitudinal ligaments running up the entire spine, as well as ligaments about the facet joints.

For our purposes, we will focus on the ligaments of the upper cervical spine. Thus, C1 is connected to C2 most importantly for understanding whiplash injuries, via the transverse ligament around the odontoid or dens. The two alar ligaments connect the odontoid process of C2 to the lateral masses of C1 and to the occipital condyles or lowest joints, of the skull.

Transverse Ligament

Alar Ligament

The transverse ligament limits forward motion of C1 on C2 and facilitates rotation of C1 on C2. The alar ligaments act to limit lateral sliding of C1 on C2 and as check ligaments to limit rotation of the skull on C1. We will see later, the crucial importance of the transverse and alar ligaments to whiplash injuries to the neck and the Whiplash Associated Disorder and Cranial-Cervical Syndrome (WAD/CCS).

More information about Cervical Fusion

Cranio-Cervical Syndrome (CCS) Symposium – April 6, 2013, Joel Franck, MD.