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Had cervical fusion surgery done. Noticed head tilting to one side. Are they related?

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Neurologist, Surgical
Practicing since : 1997
Answered : 65 Questions
Two months ago, had cervical fusion surgery to replace disc C4-5. Bone graft from hip was used with out a metal plate. Because a metal plate was not used, had to wear a neck brace for 4-6 weeks. Notice head was tilted to right side in neck brace but thought that was normal and a defect in the neck brace. About a month after surgery, realized that head tilted even without brace and was not in straight alignment. Chin points slightly upward toward  left shoulder and top of head in direction of right side of body. The procedure was anterior with the incision on the right side of neck. Before the surgery, head was in proper alignment (i.e., straight).
What causes head to be out of alignment (i.e., tilt) after cervical fusion surgery? Is it easily corrected? What treatments are effective? How long does it take before head returns to proper positioning?
Posted Sun, 3 Mar 2013 in Stroke
Answered by Dr. Shivakumar S. Kupanur 2 hours later

Thanks for posting your query.

There are multiple causes for this condition. Most common are graft displacement or graft shrinkage. Other causes to mention are neuromuscular dysfunction, muscle weakness or spasm. Rarely, it could be functional as well, i.e. you have become accustomed to that position over the period of time.

Cervical X-ray or CT scan would be mandatory to find out the graft pathology. If you are experiencing unilateral pain (right side), it could be probably due to muscle spasm. Ultimately, you need a proper clinical examination to come to any conclusion.

I would suggest you to see your treating surgeon for evaluation. Treatment option and the time period for recovery depends upon the cause which can be discussed once the cause is confirmed. You can contact me once the investigations are done so that I can give you more specific answers.

I hope, I have answered your query. I am available for your follow up query.

Get well soon.

Above answer was peer-reviewed by
Follow-up: Had cervical fusion surgery done. Noticed head tilting to one side. Are they related? 14 days later
Please interpret the following MRI impression which was taken post cervical fusion (C4-5):

Impression: when compared to August 2012, there has been interval discectomy at the C4-5 level. Previously noted to large right paracentral disc protrusion is no longer identified. There is no evidence of cord compression. Foci increased signal within the dorsal aspect of the cervical cord at this level are associated with no pathologic contrast enhancement, and are most compatible with myelomalacia.

In this case,Can the spinal cord repair itself from the herinated disc? What will help the process and what is the probability and timeline?
Answered by Dr. Shivakumar S. Kupanur 8 hours later
Hello again.

According to your MRI report, myelomalacia changes are evident. Apart from that, rest of of the report is quite good.

These changes seems to be pre-surgery due pressure effect of herniated disc for longer time. Though, now the disc has been removed, these changes takes its own time to recover. It could vary from weeks to months. Sometimes, some residual effects stays forever.

Physiotherapy can help to recover faster and also Neurovitamins like Neurobion can be added for faster cord healing. You can XXXXXXX your treating doctor to get it prescribed.

I hope, this answers your query. I will be available for follow up queries if any.

Above answer was peer-reviewed by
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