I’ve been reading up on neck fusions since I’m expecting to have one this year. I see there are many different views on this subject. Some doctors think it’s better to do the surgery from the front of the neck, others from behind. What can you tell me about this?

For a long time, surgery was only done on the neck from the back or posterior approach. This causes some problems with wound drainage and infection. There is also the risk of cutting the spinal cord, the nerve roots, or the lining around the spinal cord. The result could be permanent nerve damage or paralysis.

Using the posterior approach, the doctor often cuts through the bone and removes part (or all) of the facet joint. When more than 50 percent of the joint is removed, the spine can become unstable.

More recently, opening the spine from the front or anterior approach has gained in favor. The doctor can avoid the spinal cord with this method. However, there are blood vessels and soft tissues to work around. Too much pull or an accidental cut can lead to serious injury.

A recent study from Thomas Jefferson University in Philadelphia reviewed the cases of 19 patients who had a posterior surgery. They found that this method is both safe and effective when the cause of the problem is disc herniation to the side.