Anterior Cervical Discectomy and Fusion

(ACDF)

What is an Anterior Cervical Discectomy and Fusion?

Anterior cervical discectomy and fusion (ACDF) refers to a neck surgery that helps to remove a herniated disc or bone spurs in the neck 1. This helps to relieve the pressure and alleviates pain, weakness, numbness, and tingling in the neck. This surgery comprises two parts: anterior cervical discectomy and fusion. A discectomy usually means cutting out the disc which neurosurgeons perform anywhere along the spine from the neck to the lower back.

Anterior cervical discectomy approaches through the anterior of the cervical spine or neck. This process removes the disc from between two vertebral bones. Depending on the particular symptoms, neurosurgeons remove one disc (single-level) or more (multi-level). Additionally, the neurosurgeon performs a fusion surgery at the same time to stabilize the neck. This surgery involves placing bone grafts or implants to provide stability and strength to the area.

ACDF

Conditions for Anterior Cervical Discectomy and Fusion

Neurosurgeons recommend a patient undergo ACDF surgery when the symptoms persist for several weeks or months and do not respond to any physical therapy or medication. Ideal candidates for discectomy should possess any of the following 2:

ACDF surgery may be helpful to treat the following conditions 3:

  • Correction of a bulging and herniated disc
  • Degenerative disc disease
  • A worn or injured disc
  • Bony spurs (osteophytes) on the vertebrae that cause pain

Risks of Anterior Cervical Discectomy and Fusion

Complications can occur during any surgery. Studies show ACDF Surgeries to have high success rates between 93 to 100%. Potential risks associated with ACDF surgery include 4:

  • Infection
  • Hematoma
  • Delayed wound healing
  • Excessive loss of blood
  • Adverse reaction with anesthesia
  • Respiratory insufficiency
  • Nerve or muscle damage
  • Chronic neck pain
  • Allergic reaction to the implants
  • Formation of painful pseudoarthrosis
  • Mechanical complications of the graft such as loosening or migration of the graft.

Other complications of ACDF surgery includes dysphagia, radiculopathy, esophageal perforation, recurrent laryngeal nerve palsy, Horner’s myelopathy, and instrument failure.

How should a patient prepare for an Anterior Cervical Discectomy and Fusion procedure?

Preparation for an ACDF surgery requires prior discussion with the neurosurgeons about the qualifications for the surgery. Healthcare providers will recommend performing blood tests, X-rays, or electrocardiogram (ECG) tests before the surgery. Never drink or eat any food during the 12 hours before the procedure. Patients need to share any medication or dietary supplements that they use with the neurosurgeons prior to the surgery.

How does a Spinal Surgeon perform Anterior Cervical Discectomy and Fusion?

ACDF surgery requires an expert surgical team led by an expert neurosurgeon with a vascular surgeon, an anesthesiologist, and nurses. Many spine surgeons have specialized training to perform this ACDF surgery. The basic steps include 5:

  • Patients need to lie on their backs on the operating table.
  • Anesthesiologists will administer general anesthesia to help the patient remain unconscious throughout the entire surgery.
  • Nurses will prepare the incision site and monitor the vital signs of the patient’s body such as heart rate, respiration, etc.
  • Neurosurgeons will make a 2-inch skin incision on the right or left side of the patient’s neck.
  • Neurosurgeons will make a tunnel to the spine by moving aside the muscles, blood vessels, esophagus, and trachea to see the bony vertebrae and discs.
  • With the aid of a fluoroscope, the neurosurgeon will pass a thin needle into the disc to locate the affected vertebra and disc.
  • Neurosurgeons will use tools to remove any bone spurs from the affected vertebral space that cause pain or compress the nerve.
  • Later, the neurosurgeons will take a piece of bone from the neck (autograft), or from a donor (allograft) to fill in any empty space left behind by the removed bone material.
  • This bone graft helps to support the disc space and promote bone healing into a solid bone.
  • Finally, surgeons will put back the structures like blood vessels, esophagus, trachea, and muscles to their normal place and suture the skin together.

How long does an Anterior Cervical Discectomy and Fusion procedure typically take?

An ACDF surgery requires 1 to 4 hours to perform depending on the patient’s condition and the number of discs removed. Complications during the operation can make the condition worse and take more time.

What does recovery from an Anterior Cervical Discectomy and Fusion look like?

Recovery from an ACDF surgery generally lasts 4 to 6 weeks. Patients need to schedule a follow-up appointment with the neurosurgeon 2 weeks after the surgery. Neurosurgeons will check the patient’s progress by performing an X-ray to make sure the area heals properly. Neurosurgeons suggest a cervical collar or brace during the recovery process to support the neck and promote healing. Patients need to avoid over lifting and maintain good posture during sitting, standing, moving and sleeping.

References

  1. Buttermann, G. R. Anterior cervical discectomy and fusion outcomes over 10 years: A prospective study. Spine (Phila. Pa. 1976). 43, 207–214 (2018).
  2. Haghnegahdar, A. & Sedighi, M. An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population. Neurosci. J. 2016, 1–7 (2016).
  3. Yang, S. D. et al. Anterior cervical discectomy and fusion surgery versus total disc replacement: A comparative study with minimum of 10-year follow-up. Sci. Rep. 7, 1–7 (2017).
  4. Spanos, S. L., Siasios, I. D., Dimopoulos, V. G. & Fountas, K. N. Anterior Cervical Discectomy and Fusion: Practice Patterns Among Greek Spinal Surgeons. J. Clin. Med. Res. 8, 506–512 (2016).
  5. Sugawara, T. Anterior cervical spine surgery for degenerative disease: A review. Neurol. Med. Chir. (Tokyo). 55, 540–546 (2015).

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