Trapezius muscle pain is unfortunately common after cervical fusion surgery. The trapezius muscle is a large, flat muscle that spans the upper back and neck region. Cervical fusion surgery can alter biomechanics and increase stress on the surrounding muscles, including the trapezius. Detachment, weakness and atrophy of the trapezius muscle can contribute to pain and stiffness. Dr. Todd Lanman is well aware of this surgical complication and has developed techniques to minimize your risk. The following article discusses what you need to know about trapezius muscle pain after cervical fusion surgery.
What Is Cervical Fusion Surgery?
Cervical fusion is a surgical procedure that joins two or more vertebrae in the neck into a single, solid bone. The goal is to stop movement between the affected vertebrae and prevent further damage or irritation to the nerves and spinal cord. It is typically recommended when more conservative treatments like physical therapy and medications have failed to provide relief for conditions like degenerative disc disease, herniated discs, spinal stenosis, or spinal instability.
Trapezius Muscle and Cervical Fusion
The trapezius muscle is a large, flat muscle that spans the upper back and neck region. It originates from the occipital bone at the base of the skull, the ligamentum nuchae, and the spinous processes of the 7th cervical and all the thoracic vertebrae. The muscle fibers then converge to insert on the lateral third of the clavicle, the acromion process, and the spine of the scapula.
Cervical fusion surgery can lead to altered biomechanics and increased stress on the surrounding muscles, including the trapezius. Detachment and atrophy of the trapezius muscle can contribute to pain and stiffness in this area. Nerve impingement or irritation from the surgical site can cause muscle spasms, tightness, and inflammation in the trapezius as the body adjusts to the changes.
Conditions That Can Be Treated with Neck Fusion Surgery
Some common conditions that can be treated with neck fusion surgery include:
Degenerative Disc Disease: Degeneration of the intervertebral discs in the cervical spine can lead to instability, pain, and nerve compression. Cervical fusion surgery can help stabilize the affected spinal segment and relieve pressure on the nerves.
Herniated or Bulging Discs: A herniated or bulging disc in the neck can cause pain, numbness, and weakness by compressing the nerve roots. Anterior cervical discectomy and fusion (ACDF) can remove the damaged disc and fuse the vertebrae to restore stability.
Spinal Stenosis: Narrowing of the spinal canal in the neck can cause compression of the spinal cord and nerve roots. Cervical fusion surgery can help widen the spinal canal and decompress the affected structures.
Spondylolisthesis: Forward slippage of one vertebra over the one below it, often causing instability and nerve compression. Fusion surgery can realign and stabilize the affected spinal segment.
Traumatic Injuries: Fractures, dislocations, or other traumatic injuries to the cervical spine may require fusion surgery to stabilize the spine and prevent further damage.
Abnormal Spinal Curvatures: Congenital or acquired spinal deformities like kyphosis or scoliosis may be treated with fusion surgery to realign the spine.
Types of Muscle Pain from a Cervical Fusion Surgery
Not all types of muscle pain from cervical fusion surgery is the same, the most common types are:
Neck pain that persists even after surgery: Some patients may still have neck pain similar to what they had before the surgery.
Numbness, tingling, and/or shooting pain: Numbness, tingling or pain radiating to the shoulders and down the arms suggest nerve irritation or compression. It may also be caused by temporary irritation or inflammation caused by the procedure itself.
Muscle stiffness: A sensation of stiffness in the neck muscles is likely due to muscle retraction that occurred during the procedure.
Cramps and spasms: Involuntary contractions or spasms in the neck muscles can cause pain and discomfort. This is also likely caused by muscle retraction and manipulation during the procedure.
Intense neck pain: Sharp, severe, or intense pain in the neck region can occur after surgery, but this is not normal. If you experience severe neck pain after fusion, contact your doctor. Ask for a CT scan if you have had a fusion.
Trapezius Pain After Cervical Fusion
Trapezius pain after cervical fusion is pain that occurs in the muscles of the neck and upper back. It is quite common in patients who have posterior neck surgery, including posterior cervical fusion and posterior laminectomy. It is more likely to occur with surgeries of the lower cervical discs (C6-C7) as opposed to the higher discs (C3-C4).
Causes of Trapezius Pain After Cervical Fusion
Changes in Neck Mechanics
During fusion, your spine surgeon will place hardware to hold the spinal bones in place so they can heal. This hardware (rods, screws, etc.) can change the way your neck moves and supports the weight of your neck. These biomechanical changes can lead to trapezius muscle pain and soreness. Alignment may be improperly set during surgery.
Nerve Compression and Irritation
Uncommonly, nerves can be compressed during the cervical fusion that cause trapezius muscle pain. In most cases, however, cervical fusion relieves nerve pain rather than be a cause of new nerve pain.
Advantages of Artificial Disc Replacement Over Fusion
Artificial disc replacement is associated with far less trapezius muscle pain that cervical fusion, especially posterior cervical fusion. One big reason is that ADR involves an anterior approach, so the trapezius muscle does not need to be retracted. Another important reason is that artificial disc replacement does not require any instrumentation like rods, plates, or screw in the side of the vertebral bones. Lastly, artificial discs mimic the shape and function of the natural disc, so the spine’s biomechanics are far more natural than they would be after cervical fusion.
Final Thoughts from Dr. Lanman
Rather than relying solely on traditional fusion techniques, Dr. Lanman encourages patients to consider artificial disc replacement (ADR). ADR is associated with significantly less trapezius muscle pain compared to cervical fusion, as it avoids the need for extensive muscle retraction and the use of rigid spinal instrumentation. By preserving the natural biomechanics of the spine, ADR can help mitigate the risk of persistent muscle tightness, spasms, and other complications that can arise from the altered mechanics of a fused spine. If you are concerned about pain after spine surgery, contact Dr. Todd Lanman for a consultation to discuss your unique case and needs.
FAQS:
What are the typical symptoms of trapezius pain after cervical fusion surgery?
The typical symptoms of trapezius pain after cervical fusion surgery are neck pain and stiffness, upper back and shoulder pain, neck muscle stiffness and spasms, and possibly radiating pain, numbness, and tingling if nerves are also affected.
How soon after surgery can trapezius pain develop?
Trapezius pain and upper back/shoulder discomfort often starts soon after the surgery.
Are there any non-surgical options for managing trapezius pain?
Yes. Trapezius pain can sometimes be managed with physical therapy, manual therapies (massage, chiropractic), heat, and Transcutaneous Electrical Nerve Stimulation (TENS). Of course, analgesics like ibuprofen, naproxen, or acetaminophen are also helpful.
How does artificial disc replacement differ from cervical fusion?
In both procedures, the spine surgeon removes the natural disc. In cervical fusion, the two surrounding spinal bones are then united, so they fuse together. In artificial disc replacement, a medical device that mimics the natural disc is placed where the natural disc once existed.
What are the eligibility criteria for artificial disc replacement?
Chronic pain and/or symptoms not relieved by conservative treatments, no osteoporosis, no cancer, open facet joints, and no evidence of segmental instability.
What are the potential risks and complications associated with artificial disc replacement?
General surgical risks include infection, excessive bleeding, and an adverse reaction to anesthesia. Cervical ADR may cause difficulty speaking, difficulty swallowing, and throat soreness, which are usually temporary. The artificial disc may migrate to an undesirable location. Rare complications include nerve damage, blood vessel damage, and paralysis.
How successful is artificial disc replacement in relieving trapezius pain compared to fusion?
Studies have shown that patients who undergo artificial disc replacement experience better pain relief and functional outcomes compared to those who have fusion surgery; however, they are similar in their ability to relieve trapezius pain. Importantly, trapezius muscle pain is a known complication of cervical spinal fusion surgery, but is less likely to occur after artificial disc replacement.
