Anterior Cervical Discectomy and Fusion (ACDF)


 

What are the indications for an ACDF?

Anterior Cervical Discectomy and Fusion (ACDF) is the most common neck surgery performed by spinal surgeons. The goal of the surgery is to remove the herniated disc and bone spurs (if present)  to relieve the pressure on the spinal cord or nerves. An ACDF is indicated for severe pain caused by a pinched nerve or nerve pain not relieved with conservative options such as medications, physical therapy, or injections. Surgery is strongly recommended if there is progressive damage to the spinal cord or nerves resulting in arm/leg weakness/numbness/incoordination.  

How is an ACDF surgery performed?

The surgery is performed under general anesthesia. A small incision (approximately one inch) is made in the throat area just slightly to the right of the midline. The approach is made between the muscles of the neck. The trachea (windpipe) and esophagus (food pipe) are gently moved toward the left side and the disc is exposed. The disc material is removed. Once the back end of the disc is reached close to the spinal cord and nerves, the microscope is brought in to obtain a magnified view of the herniated disc and bone spurs. The remaining disc material and bone spurs are then safely removed to relieve pressure on the spinal cord and nerves. After the disc is removed, the space between the bony vertebrae is empty. To prevent the vertebrae from collapsing and rubbing together, a spacer filled with bone graft material is placed in the empty disc space. The bone graft material serves as a bridge between the two vertebrae to create a spinal fusion. A metal (titanium) plate is placed across the disc space with screws anchored to the vertebrae above and below to provide additional fixation and stability. The spacer, plate and screws do not set off any alarms at airports and do not restrict from obtaining future MRI studies. The incision is closed with absorbable sutures. The surgery typically takes 1 hour to 90 minutes for a single disc procedure. A 2 level disc procedure takes slightly longer than 2 hours. In the majority of cases, surgery is performed at one or two disc levels, rarely three.  

What is the recovery from an ACDF?

The surgery is typically an overnight stay. After the surgery, most patients will experience pain in the back of the neck and radiating into the shoulder blades. This postsurgical pain can last anywhere from several weeks to 8 weeks. The nerve pain (felt as the pain into the arm) may resolve immediately after surgery or may persist for 4-6 weeks after surgery. Usually by 6-8 weeks, the majority of the nerve pain will go away.  Nerve pain can continue to improve for up to 1-2 years after the surgery. Difficulty swallowing is a common issue after the surgery. It is initially recommended to eat soft, puree type foods and chew food well prior to swallowing. Most swallowing difficulties usually resolve or are significantly improved within the first 2 months. We recommend no driving for 2 weeks after the surgery. Return to work can vary depending on extent of surgery, rate of recovery, and type of job performed. For a nonphysical job, reasonable timeline to return to work is 2 weeks to 2 months whereas more labor intensive work may require to be out of work for 3 months.

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