Anterior Cervical Discectomy and Fusion (ACDF)
Anterior cervical discectomy and fusion, or ACDF, is a surgical procedure used to treat degenerated discs in the neck or cervical spine.
Who is a candidate for an ACDF?
Patients with neck pain and/or arm pain, weakness or numbness who have failed conservative measures (physical therapy, medications, injections, etc.) and who have evidence of disc degeneration or herniation on MRI are candidates for an ACDF.
What happens during surgery?
The patient is brought to an operating room and placed under general anesthesia with a breathing tube for the duration of surgery. A small incision is made in the front of the neck, usually in an existing skin crease to make the scar less visible after surgery. Normal structures in the neck, including the esophagus, trachea, nerves, and blood vessels are moved aside, and a retractor is placed, creating a small tunnel to the spine.
The degenerated disc and bone spurs are then completely removed under microscope magnification to take the pressure off the spinal cord and nerves – this is the discectomy part of the procedure. Once the disc is removed, a synthetic spacer packed with material that promotes bone healing is placed in the disc space. Over time, the vertebrae immediately above and below the spacer heal together into one block of bone – this process is called a fusion. Fusing one disc space in the cervical spine typically leads to a loss of about 10 degrees of motion – an amount that most people do not notice. This process is then repeated for any other discs that need to be treated. A thin titanium plate is then placed on top of the spine and secured to the vertebrae with small titanium screws in order to provide stability while the fusion is taking place. The plate and screws do not need to be removed and do not set off the metal detector at the airport.
If more than one disc is treated, a small drain may be placed and brought out through the skin to collect any fluid or blood after surgery, usually for about one day. The incision is then closed with sutures that stay under the skin and dissolve over time, so no suture removal is necessary. A sterile dressing is placed that stays on for two days. If your surgery involves 3 or more levels or if you have other risk factors for non-fusion, you may need to wear a cervical collar for 6 weeks after surgery; otherwise, no brace is necessary.
What is the recovery like?
The patients typically spend one night in the hospital and, if there are no complications, are discharged home the next day. The main restrictions are no heavy lifting (no more than 10 lbs. for the first 6 weeks, no more than 20 lbs. for the next 6 weeks, and no more than 40 lbs. for the next 3 months) and no repetitive bending or twisting of the neck. Most patients return to light duty or office-type work in 1-2 weeks, to light-to medium-labor in 3-6 months, and to heavy labor in 9-12 months. Physical therapy is started at 6 weeks if necessary.
What follow-up care is necessary?
The patient is seen one week after surgery, and then at 6 weeks, 3 months, 6 months, and one year after surgery. X-rays are performed along the way to assess progression of fusion.
What are the risks of an ACDF?
Serious or permanent complications are rare (risk for most is less than 1%) and include bleeding, infection, difficulty swallowing, hoarseness, failure of fusion to “take” (higher risk for smokers and in multi-level surgery), injury to nerves or spinal cord, spinal fluid leak, and failure of symptoms to resolve despite surgery.
What are the benefits of an ACDF?
Most patients do very well after an ACDF with significant improvement or complete resolution of arm pain. Numbness/tingling and weakness may take longer to improve and in rare cases may be permanent despite surgery. Neck pain may or may not improve with surgery.