Anterior Cervical Discectomy and Fusion Spine Surgery

Anterior Cervical Discectomy and Fusion

Candidates for an Anterior Cervical Discectomy and Fusion, or ACDF, typically suffer from a symptomatic herniated disc in the neck (cervical spine). Less commonly, an ACDF may be recommended to treat cervical degenerative disc disease, bone spurs caused by arthritis or cervical spinal stenosis. One or more discs may be affected by herniation or degeneration, causing acute or chronic pain, muscle weakness or numbness. Your surgeon may perform a one-level or multilevel ACDF, depending on the number of affected discs.

What is an Anterior Cervical Discectomy and Fusion?

An ACDF is a surgical procedure performed on the neck, or cervical spine, in which one or several damaged discs are removed and replaced with bone graft-filled spacers. The damaged discs tend to put pressure on the spinal cord or nerve root and the goal of the procedure is to decompress the damaged area.

The Anterior Cervical Discectomy and Fusion is conducted through a small incision in the front of the neck (anterior), providing direct access to the disc(s) and ample visualization, as opposed to approaching the procedure through the back of the neck (posterior). The incision is typically made along a natural line along the skin of the neck to minimize scarring. One thin vestigial muscle is cut in line with the skin incision and the surgeon follows anatomic planes through the muscles, down to the spine to access the discs.

Once the surgeon approaches the spine, a thin fascia covering the spine is dissected to access the discs. X-ray imaging provides visualization as the surgeon identifies the correct discs, the outer annulus fibrosis is cut and the nucleus pulposus is removed. The entire disc is removed, including the cartilage endplates, to reveal the cortical bone.

Following the discectomy, an anterior cervical fusion is performed. Bone graft and/or an implant or cage are placed into the spaces where discs were removed to prevent collapse and maintain proper spacing. The insertions promote growth between the vertebrae, fusing the two (or more) into a single unit (fusion). The goal is to maintain decompression and allow adequate spacing for the nerve roots and spinal cord.

A plate may often be attached to the front of the spine with screws to provide additional stability and facilitate the fusion process.

Results of an Anterior Cervical Discectomy and Fusion Procedure

Patients are typically able to return home the same day as their ACDF procedures. Some may spend one night in the hospital and most will recover within four to six weeks. Regular activity is possible within a few days or weeks. The fusion will fully mature typically within 12 to 18 months.

The intended outcome of an ACDF procedure is for the nerve roots and spinal cord to be decompressed, relieving the patient of his or her pain, weakness, numbness and/or tingling.

What are the risks of an Anterior Cervical Discectomy and Fusion?

Certain risks are present and will vary from patient to patient. The patient’s conditions will factor into recovery time and outcome, including bone strength, diabetes, smoking and physical health. In some patients, symptoms may not be adequately relieved from the ACDF procedure. The fusion may not fully mature, resulting in pseudarthrosis. Temporary or persistent dysphasia, or swallowing, may occur. Speech may also be disturbed, caused by injury to the recurrent laryngeal nerve that supplies vocal cords.

A dural tear or spinal fluid leak, nerve root damage, spinal cord damage, bleeding, infection, damage to the trachea or esophagus or a hematoma or seroma may also occur.