Anterior Cervical Discectomy and Fusion

Anterior cervical discectomy and fusion (ACDF) is a surgical procedure in which a damaged intervertebral disc in the neck region is removed and the vertebrae above and below are fused together. Certain spine disorders, e.g., herniated/degenerative disc and spinal instability, can be successfully treated with ACDF.

Disc disorders may cause nerve impingement or intrude into the space surrounding the spinal cord, resulting in neck, shoulder, or arm pain. Patients may also experience numbness, tingling, or weakness in the arms or hands. The goal of ACDF is to decompress the nerve root(s) and spinal cord, 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 – surgical union of vertebrae

The Procedure

Treatment options for cervical spine disorders include medication, physical therapy, and spinal injections. For patients with significant neurologic deficit or debilitating pain, surgical intervention may be the best option.

Surgery is performed under general anesthesia. An incision is made on the left or right side of the neck. For cosmetic purposes, the incision can often be made within a natural skin fold. Soft tissue is gently moved aside and access to the front of the spine is achieved. A thin needle is inserted into the disc.

Fluoroscopy (real-time X-ray) is used throughout the surgery to enhance visualization of the operative site. Specialized instruments are used to remove the ruptured disc. A surgical dilator gently separates the vertebral bodies while the disc and smaller disc pieces are removed. Once the surgeon has removed whatever is irritating or compressing the spinal nerve(s), bone graft is inserted into the empty space between the affected vertebrae. Hardware, such as rods and screws, is implanted to stabilize the neck and facilitate fusion. 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 patients’ neck during laminectomy or it may be taken from the patients’ hip in a separate procedure. 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. The length of hospital stay is determined by factors such as patient age and overall state of health. Patients are usually required to wear a cervical brace or collar for a period of time following surgery, as it takes several months for the vertebrae to fully “fuse.” Cervical braces are prescribed to help immobilize and support the neck during recovery.

Once discharged, patients typically experience a significant reduction in pain. Instructions regarding pain control, diet, wound care, and follow-up appointments are provided. Most important, activity restrictions are reviewed prior to discharge. Although activity will be restricted in the early stages of recovery, most patients experience a steady progression in level of function during the weeks and months following surgery.