Anterior Cervical Discectomy & Fusion
Anterior cervical discectomy and fusion, or ACDF, is a surgical procedure to remove a herniated or degenerative disc of the spine, using anterior (frontal) approach to the spine through the throat region.
Your surgeon moves aside neck muscles, the trachea and esophagus to access the spine. For cervical (neck) spinal surgeries, the anterior approach is more convenient because it lets your doctor work without disturbing the spinal cord, spinal nerves or the back muscles.
A discectomy may be either single-level or multi-level:
- Single-level: one disc is removed
- Multi-level: multiple discs are removed
Once removed, the space between vertebrae must be filled, and a bone graft is most commonly performed to prevent the vertebrae from collapsing.
Your surgeon will fuse the bone graft together with the other vertebrae by use of metal plates and screws, which may, in turn, eventually be grown over with new bone cells as the bone heals.
There are three types of bone grafts used in ACDF:
- Autograft: bone comes from you, taken from the hip (iliac crest), which has a higher number of bone-growing cells and proteins
- Allograft: bone comes from a donor (cadaver)
- Artificial: manmade plastic, ceramic, or other compounds
Autograft is the “gold standard” for rapid healing and spinal fusion, but the harvesting of bone cells can be painful.
Spinal fusion may produce some loss of motion, particularly in a multi-level discectomy.
Artificial discs have been developed which may preserve the range of motion in the neck.
When to Get ACDF?
Most herniated disc injuries heal a few months after nonsurgical treatment, but in cases where the pain is significant enough and nonsurgical options have not relieved it, surgery may be considered.
ACDF is a helpful procedure when physical therapy or medication has proven ineffective at relieving pain and weakness in arms or hands, or in the case of herniated or degenerative disc disorder.
A neurosurgeon, orthopedic surgeon, or spine surgeon may perform the surgery.
Quitting smoking is one of the most important things a patient can do to help their spinal surgery be successful. Nicotine prevents bone growth and can cause complications that lead to failed bone fusion.
Studies have shown that spinal fusion fails in as many as 40 percent of smokers, compared with only eight percent of nonsmokers.
Smoking also inhibits blood circulation, which results in slower wound healing.
Northwestern Memorial offers a Smoking Cessation Program that can help you quit smoking ahead of your surgery.
Because of the importance of successful bone healing, there are a number of restrictions for a patient who has undergone ACDF, including:
- Avoiding any non-steroidal anti-inflammatory drugs (NSAIDs, like aspirin, ibuprofen, Advil®, Motrin®, Nuprin®, Aleve®) for six months after surgery. NSAIDs may cause bleeding and may interfere with bone healing
- No smoking
- No driving for two to four weeks after surgery, pending approval from your surgeon
- No lifting anything heavier than five pounds
- No house- or yard work (e.g., gardening, mowing the lawn, vacuuming, ironing, loading/unloading the dishwasher, washer or dryer)
- No sitting for long periods of time
- No bending of the head forward or backward
- No sexual activity until your surgeon specifies otherwise
ACDF, like all spinal surgery, is not without potential complications.
Some specific complications of ACDF include:
- Hoarseness and/or swallowing difficulties: the recurrent laryngeal nerve may be affected during surgery, which can cause temporary hoarseness or swallowing difficulties as the nerve recovers
- Instrumentation fracture: the screws, plates and rods used to stabilize the spine (instrumentation) may move or break before spinal fusion is complete; this may require additional surgery to repair
- Failure of spinal fusion: smoking and other lifestyle issues like obesity and malnutrition can adversely affect spinal fusion
- Transitional syndrome: also known as adjacent-segment disease, this is when adjacent vertebrae undergo increased stress in the wake of fusion, and suffer degeneration, which can cause pain
- Bone graft migration: rarely, the bone graft can move into an incorrect position; this can happen if the instrumentation is not used to secure the graft, and is more common in multi-level ACDF
- Nerve damage: spinal surgery always carries some risk of nerve or spinal cord damage, including numbness and paralysis; in many cases nerve damage from the herniated disc can cause persistent pain
For patients for whom ACDF is considered, the majority experience relief from the chronic pain of their condition, particularly in arm pain.
Neck pain is also relieved, although usually less significantly than arm pain.
Patients may experience numbness and weakness in arms that lasts for weeks or months.
Spinal fusion is likelier to occur with ACDF, bone graft, and use of instrumentation.