Anterior cervical discectomy and fusion (ACDF) is a spine surgery procedure in which a spine surgeon removes a damaged intervertebral disc in the neck then places bone or bone-like material in its place to fuse the two remaining vertebrae together.
Each word in anterior cervical discectomy and fusion describes something about the procedure:
Anterior – The spine surgeon gains access to the spine from the front (anterior side) of the neck.
Cervical – The cervical spine is made up of the top 7 spinal bones (vertebrae), commonly called the neck.
Discectomy – The suffix “-ectomy” means to remove, thus discectomy is the removal of a spinal disc.
Fusion – The spinal bones above and below the removed spinal disc are fused together (though actual fusion does not take place immediately; fusion only occurs after the bones have knitted together during recovery).
Anterior cervical discectomy and fusion can be remarkably helpful for those with neck pain and symptoms caused by a diseased or damaged cervical disc. Anterior cervical discectomy and fusion is usually reserved for people who have had neck, shoulder, and/or arm symptoms for weeks to months that have not improved after various conservative treatments. This spine surgery procedure can relieve pain and arm weakness or numbness caused by a herniated cervical disc, cervical degenerative disc disease, cervical spinal stenosis, and/or cervical osteophytes (cervical bone spurs).
Once the patient is placed under general anesthesia, the spine surgeon makes a small (1-2 inch) incision in the neck, just off to one side. Only one thin muscle and some thin fascia needs to be cut (this reduces postoperative pain), the other muscles and structures are gently held to the side with clamps. Despite the small incision, the spine surgeon can visualize and reach the entire affected area. A portable X-ray machine called a fluoroscope may be used to provide detailed images of the spine.
It is important that the entire cervical disc is removed, including and especially any portions that are pressing on nerves, nerve roots, or the spinal cord. This is usually the most delicate and challenging part of the ACDF procedure. An operating microscope or loupes (magnifying lenses worn by the surgeon) may be needed to perform this step.
Once the entire disc has been removed, the spinal bones are prepared. Because the goal of fusion is for the bones to heal as one unit, the outer layer of cartilage/bone is removed from the top and bottom of the vertebrae (i.e., the surfaces of the bones that once faced the damaged disc). These exposed surfaces are naturally inclined to heal, like the edges of a broken bone knit together over time.
The distance between vertebral bones is too great for the spinal bones to fuse without assistance, however. In the past, a small bit of bone, usually taken from the patient’s (or donor’s) pelvis or rib, is inserted into the space between the spinal bones. But now, instead of using the patients own bone graft from the hip we use a bone graft substitute such as demineralized bone matrix, synthetic bone graft extenders, or bone morphogenetic proteins. Because it takes several months for the spinal bones to fuse together, a metal, plastic or bone shaped cage is placed in between the spinal bones to hold them in place until spinal fusion is complete (though the cage will remain in place permanently). Finally, a titanium plate is fixed to the spine to hold the vertebrae together and in alignment while it heals.
The structures of the neck are carefully placed in their original state and the incision is closed with dissolving sutures. A dressing in placed over the incision and the patient is moved to post-anesthesia care.
Despite being a major surgery involving the spine, most patients—specifically those who are young and relatively healthy—are able to return home on the same day of ACDF. Most others need to only spend one night in the hospital. Despite being able to return home rather quickly, patients should anticipate some restrictions immediately after the procedure. The spine surgeon will provide detailed and specific instructions about how to care for the surgical wound, what activities to avoid and for how long.
Twisting, lifting, pushing, and pulling should be avoided as much as possible for several weeks after surgery. A rule of thumb is no more than 5-10 pounds (which is not very much weight). Walking with the neck held up and straight, on the other hand, is safe, healthy, and even beneficial to healing.
Patients are encouraged to eat a diet of soft foods for 1-2 weeks. Patients should not drive if they are taking opioids for pain, but can generally start driving quite soon after the procedure once they have moved to Tylenol and stopped taking pain medications. We advise not to take NSAIDs for 3 months as they inhibit bone healing for a fusion.
Patients may not be able to return to work for several weeks after surgery. Those who perform any sort of physical labor as part of their jobs often require longer recovery times (6 to 8 weeks) than those who do not.
Fortunately, most patients enjoy substantial pain and symptom relief from anterior cervical discectomy and fusion. Because the cervical disc is no longer pressing on vital structures and the vertebral bones are correctly spaced, there are no sources of pain or dysfunction at that level of the spine. However, patients should be aware that since two spinal bones have been fused together, the neck will not be as flexible and mobile as it once was. It is normal and expected after ACDF to have at least some limitation on spine flexibility and range of motion. This trade-off may be a small price to pay for people who have suffered from longstanding, hard-to-treat neck pain, but patients should be aware of this potential limitation before choosing to undergo anterior cervical discectomy and fusion.
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