Anterior Cervical Discectomy and Fusion (ACDF)

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Anterior cervical discectomy and fusion (ACDF) is a surgical procedure involving removal of a damaged intervertebral disc in the neck.  After discectomy (disc removal), instrumentation and bone graft help fuse the bones together.  Herniated discs and degenerative disc disease are conditions that cause spinal instability.  Disc disorders can cause spinal cord or nerve root impingement.  Symptoms often include neck, shoulder or arm pain with or without numbness, tingling, or weakness in the arms or hands.  An ACDF may be recommended to decompress the spinal cord and nerve roots, stabilize the neck, and relieve symptoms.

Anatomy

There are seven vertebrae in the neck (cervical region), numbered C1 (top) through C7 (bottom). The discs between the vertebrae are also abbreviated. For example, C3-C4 refers to the disc between the third and fourth cervical vertebrae.

• Anterior – surgical approach from the front
• Cervical – refers to the neck
• Discectomy – removal of a disc
• Fusion – bone graft fuses vertebrae together during healing

The Procedure

Surgery is performed under general anesthesia. An incision is made on the left or right side of the neck. For cosmetic purposes, the incision may be made within a natural skin fold. Soft tissue is gently moved to the side to exposure the spine.

Fluoroscopy (real-time X-ray) is used throughout surgery to enhance visualization of the operative site. Special instruments remove the damaged disc.  Surgical dilators gently separate tissues, expose the disc, and provide a tunnel through which the disc can be removed.  Removal of disc material and tissue decompresses--takes pressure off the spinal cord and nerve roots.  Instrumentation, such as plates and screws are implanted to immediately stabilize the neck.  Bone graft is packed into and around the instrumentation to stimulation bones to fuse, growth together.  Over a period of months, new bone grows into and around the hardware, resulting in a spinal fusion.

Types of Bone Graft

• Autograft is bone taken from the patient.
• Autograft can be harvested from the patient's neck bone or from the hip in a separate operation.
• Allograft is cadaver bone from a bone bank.

Bone graft substitute is sometimes used. Synthetic bone graft eliminates the need to harvest bone from the patient and sometimes results in a stronger fusion.

After Surgery

Many patients go home the same day as surgery or are hospitalized for a day or two. The surgeon prescribes a cervical brace or collar to be worn after surgery to help support the neck during healing.  It usually takes a few months for fusion to completely heal.

Once discharged, patients typically experience a significant reduction in pain. Instructions regarding pain control, diet, wound care, and follow up appointments are provided. Activity restrictions are reviewed prior to discharge.  Most patient steadily progress after surgery and during the weeks and months thereafter.