Anterior Cervical Discectomy and Fusion (ACDF)

Anterior cervical discectomy and fusion (ACDF) is a surgical procedure performed through the front of the neck to remove a herniated disc from the cervical spine region. The cervical spine is the upper part of the spine comprising of the first 7 vertebrae, the bones of the spinal column. These vertebrae are separated from one another by shock absorbing pads called intervertebral discs.  The normal intervertebral disc is composed of a nucleus pulposus, at the center, surrounded by a fibrous ring known as annulus fibrosis. A herniated disc, also known as a bulging disc, is a condition in which the inner gelatinous substance of the disc escapes through a tear in the outer, fibrous ring (annulus fibrosus).  This may compress the spinal cord or the surrounding nerves, resulting in neck or arm pain.  An anterior cervical discectomy is performed to remove the damaged disc and relieve the pressure on the nerve, alleviating the pain.

Anterior cervical discectomy is one of the most common surgical procedures for the management of cervical spine disorders including disc herniation, cervical degenerative disc disease, spondylosis, and spinal stenosis. The discectomy is usually combined with an anterior spinal fusion, where the vertebrae are joined together with metal plates and screws (instrumentation). The aim of this surgery is to relieve your pain and stabilize the cervical spine.

Procedure

Before the surgery, your doctor will explain the surgical procedure to you.  Your surgeon may also order blood tests, X-rays, or other imaging tests to assess your medical condition. You will also require a health clearance letter from your physician, for the surgery.

The procedure is performed under general anesthesia. You will lie on your back, on the operating table. X-rays are taken to verify the precise level of the herniated disc. Your surgeon approaches the cervical spine through a small incision in the front of the neck. The soft tissues are gently retracted, to access the cervical spine. The damaged disc, along with any loose disc fragments or bone spurs, is then removed. A bone graft, taken either from the patient’s own body (autograft) or from the donor (allograft), is then placed in the prepared disc space. The vertebrae are then stabilized with the help of a metal plate and screws. The soft tissues are repositioned and the incision is closed.

After surgery

After the surgery, you will be transferred to a recovery room and your vital signs will be monitored by the medical staff. You would be advised to wear a cervical brace to provide support and limit cervical motion during healing process. You may experience slight discomfort, pain at the incision site, neck muscle spasms, or other related symptoms after the procedure.

Post-operative care

The incision needs to be kept clean and dry. Avoid hot tubs, swimming, heavy lifting, driving, and smoking. You may begin physical therapy, as instructed by your surgeon. Take medications prescribed by your doctor. Eat healthy, nutritious food. Schedule a follow-up appointment with your surgeon.

Risks

The potential risks of ACDF surgery may include infection, bleeding, nerve injury, failure of bone graft healing (non union), problems due to anesthesia, and persistent pain.

Call your doctor if you develop fever with a temperature beyond 101° F or the incision shows signs of infection such as redness, swelling, pain, or variation in the amount and odor of the drainage. Bowel and bladder dysfunction or numbness over the genital area needs to be reported to the doctor immediately.