Anterior Cervical Discectomy & Fusion (ACDF)
Anterior cervical discectomy with fusion (ACDF) is a surgical procedure to treat a herniated disc in the cervical or neck region. The goals of surgery are to remove the damaged spinal disc or bony overgrowths causing nerve compressing and to fuse the adjacent vertebrae by placing bone graft in the space created. This procedure is performed by approaching the spine anteriorly or from the front of your neck.
There are seven vertebrae in the neck separated by intervertebral discs that act as shock absorbers. Each disc has a tough exterior called the annulus fibrosus and a gel-like centre called the nucleus pulposus. Conditions such as trauma or wear and tear can damage the disc causing the nucleus pulposus to herniate or protrude through its tough outer layer. This can put pressure on the spinal cord, ligaments or nerve roots entering and exiting the spine. Nerve compression may also be caused by bony overgrowths or spurs in the cervical spine that occur due to calcium accumulation. Cervical disc herniation causes neck pain as well as pain, numbness, weakness and lack of coordination in the arms and fingers.
ACDF surgery is indicated to treat symptoms that do not respond to non-surgical treatments and adversely affect your ability to perform your daily activities.
Anterior cervical discectomy with fusion is performed under general anaesthesia. You will lie on your back and your surgeon makes a transverse incision in the front of your neck. The muscles and other important structures in the neck are retracted to gain access to the surgical area.
- The affected cervical disc is identified by X-ray imaging.
- The disc material is surgically removed to decompress the areas of nerve root and spinal cord compression.
- Any bone spurs causing nerve or tissue compression are also removed.
- The space left after removing the disc is instrumented to receive the bone graft.
- The bone graft is prepared and placed in the intervertebral space. Alternatively, a fusion cage made of artificial material such as titanium or PEEK is packed with bone graft and inserted in the space.
- A metal plate may be screwed into the vertebrae to provide stability.
- The muscles are released and the incision is closed.
- With the help of the bone graft, the adjacent vertebrae will grow and fuse together to form a solid piece of bone.
After surgery, you are placed in a neck brace for stability and comfort, which you may wear intermittently for 2 weeks. Your doctor will prescribe appropriate medication for pain. Smoking and using non-steroidal anti-inflammatory drugs or NSAIDs should be avoided as they interfere with bone healing. You will be instructed to avoid lifting heavy objects or bending forward or backward. Post-operative exercises are recommended to safely restore movement as early as possible. You may return to work in 3-6 weeks depending on your level of activity.
The anterior approach to cervical spine surgery provides easier access to the cervical spine, minimal muscle division and less postoperative pain than the posterior approach.
Risks and Complications
As with all surgical procedures, ACDF may be associated with certain risks and complications such as
- Blood loss
- Blood clots
- Nerve damage
- Difficulty swallowing for a few days
- Bowel and bladder problems
- Fusion failure