Before a fusion of C2-3 is contemplated, there has to be diagnostic tests that indicate this level is the pain generator. These tests might include facet blocks, selective nerve root blocks, possible discograms as well as imaging studies that indicate this is the worst level (isolated disc resorption, degenerative spondylolisthesis, instability, foraminal stenosis, severe kyphosis).
I personally prefer the anterior approach as it heals faster with less problems. For this level, I generally have an ENT surgeon help with the approach as the inferior mandibular nerve is also in this area and injury to it could cause a droop around the mouth (think Silvester Stallone). I recommend an ACDF with autograft as this has the best healing potential. Posterior fusions do work well but need more time to heal, heal with a slightly lower fusion rate and have muscular pain as a higher percentage of the postoperative healing period.
Dr. Corenman
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.