Anterior Cervical Discectomy and Fusion
(ACDF)
What’s an Anterior Cervical Discectomy and Fusion?
Anterior cervical discectomy and fusion (ACDF) refer to a neck surgery that helps to remove a herniated disc or bone spurs in the neck. A commonly performed procedure for conditions such as cervical disc herniation, degenerative disc disease, and spinal stenosis that cause nerve compression and neck pain. 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.
Indicators for a Patient Who Would Benefit from an ACDF Procedure
Anterior Cervical Discectomy and Fusion (ACDF) represents a surgical procedure that alleviates neck and arm pain caused by herniated or degenerated cervical discs. Several indicators help identify patients who could benefit from an ACDF procedure.
1. Persistent Neck and Arm Pain: Patients experiencing chronic neck and arm pain, unresponsive to conservative treatments like rest, physical therapy, or medications, may qualify for ACDF.
2. Radiating Nerve Symptoms: When cervical disc herniation compresses nerve roots, it leads to radiating pain, numbness, tingling, or weakness in the arms and hands.
3. Neurological Deficits: Patients with progressive neurological deficits like muscle weakness or loss of coordination due to nerve compression may gain from ACDF.
4. Failed Non-Surgical Treatments: If other non-surgical treatments have not provided adequate relief, ACDF might be considered as an option.
5. Spinal Stability Issues: Patients with spinal instability, often caused by severe degeneration or trauma, might require ACDF to stabilize the affected spine segment.
6. Loss of Disc Height: Significant loss of disc height between cervical vertebrae due to degenerative disc disease could call for ACDF to restore stability and alleviate symptoms.
7. Cervical Disc Protrusion: MRI or CT scans revealing significant disc protrusion or herniation that affects the spinal cord or nerve roots might signal the need for ACDF.
A thorough evaluation by a qualified spine specialist proves crucial to determining the appropriateness of an ACDF procedure. Careful consideration of the patient’s symptoms, medical history, imaging results, and overall health will guide the decision-making process for optimal patient outcomes.
Conditions Treated by ACDF
Herniated Disc: A herniated disc is a common spinal condition wherein the soft, gel-like center of a spinal disc protrudes through a tear in the disc’s outer layer. This condition can lead to nerve compression, resulting in pain, weakness, and numbness in the arms.
Degenerative Disc Disease: As individuals age, their spinal discs may undergo degenerative changes, losing flexibility and cushioning ability. ACDF can offer relief by addressing pain caused by degenerative disc disease and stabilizing the affected vertebrae.
Cervical Spinal Stenosis: Spinal stenosis refers to the narrowing of the spinal canal, which can exert pressure on the spinal cord and nerves. ACDF aids in creating more space for the nerves, alleviating pain and improving mobility.
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. Patients should make the decision to undergo this surgery after a thorough evaluation and discussion with a qualified neurosurgeon or orthopedic surgeon. They can assess the patient’s condition and recommend the most suitable treatment approach for optimal outcomes.
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 Fort Worth Neurosurgeon 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 such as 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’s expected during the recovery period of Anterior Cervical Discectomy and Fusion?
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. Fort Worth 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
- Buttermann, G. R. Anterior cervical discectomy and fusion outcomes over 10 years: A prospective study. Spine (Phila. Pa. 1976). 43, 207–214 (2018).
- Haghnegahdar, A. & Sedighi, M. An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population. Neurosci. J. 2016, 1–7 (2016).
- 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).
- 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).
- Sugawara, T. Anterior cervical spine surgery for degenerative disease: A review. Neurol. Med. Chir. (Tokyo). 55, 540–546 (2015).