C4 – A short post about surgery (the good and the bad)



As we progress down the vertebral column, the shape of each vertebra changes gradually, both is size and shape – apart from anything else, they get bigger and more bulky, so their function changes too. C4 is noticeably bigger than C1 with a vertebral body which carries the disc that separates the individual bones and allows movement between each vertebra – note the long spinous process on C4 which enables the long muscles to attach and facilitates flexion and extension of the neck.

I’ve borrowed these images from digikalla.info – they’re nice and clear and demonstrate neatly the difference between the bone structures

So, in this blog I’m going to talk about a recently-published article that looks at the long-term outcomes of Posterior Spinal Fusion in scoliosis. PSF is still considered to be the most common form of spinal surgery performed in the correction of a scoliotic spine and a successful outcome carries many benefits including pain reduction, improved aesthetics, prevention of progression of curves and respiratory function, but, as with any surgical intervention, there are risks. There ‘generic’ risks of surgery, such as poor reaction to anaesthetic, infection and poor wound healing are relatively high due to the extensive nature of surgery of this nature, but there are also many factors connected directly with this type of procedure: there is the failure of the instrumentation (rods, screws etc), neurological damage, loss of spinal function and increased loading and strain on adjacent, unfused vertebrae. (I’m not trying to scare you – these complications are well-documented and all should be explained to you in detail prior to you making the decision if you opt for this treatment).


To cut a long story short, despite the risks, the outcome for PSF are actually positive in the short to medium term, with improved scores on disability and cosmetic improvement. The concerns of the authors lies in the long-term effects, particularly relating to degenerative disc disease, where the intervertebral discs become atrophied and the space between the vertebrae is reduced, causing pressure on both the facet joints and the nerves that come out from between each bone, leading to chronic pain.


The areas of complication which are only briefly discussed or mentioned are varied, and possibly of equal concern. However, it is probably sensible to reduce the variables in order to maintain clarity of argument and discussion.


All this looks like I’m trying to put you off surgery: in the right circumstances, under the right conditions, surgery should be considered a sensible, practical and safe intervention. Your surgeon and you will need to balance the benefits against all possible risks both short and long term.


Of course, my natural inclination is to manage scoliosis conservatively for as long as possible, and my aim is for you to avoid surgery by using the fantastic RSC brace, but we cannot win every battle, and sometimes surgery is the only option.


The link to the scientific paper is here:




Lots of stats and some useful discussion! For further reading, the online Scoliosis Journal is a valuable, open access resource for all professionals and people involved with scoliosis


I’d be really interested to hear experiences of those who have had surgery – bracing has been shown to be really helpful with pain management in a post-surgical situation. Feel free to contact me via www.cymortho.co.uk/contact

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