Anterior Cervical Discectomy and Fusion
An Anterior Cervical Discectomy (ACDF) is the most common surgical procedure performed to treat damaged cervical discs. It is an operation that was first described in 1955 and has been further improved over several decades. The goal is to relieve pressure on the spinal cord and/or nerve roots, clinically referred to as “decompression.” The spine is reached through a small incision at the front of the neck to remove disc tissue and bone spurs from the spine. The removed disc is replaced with bone graft or bone growth stimulant material to cause new bone growth that, over time, will ideally fuse the vertebrae together. This is usually reinforced with a small titanium plate.
This procedure is indicated in herniated nucleus pulposus (herniated disc), stenosis (spondylosis), trauma (fractures), instability, tumor, myelopathy and cervical radiculopathy. Following most of these procedures, patients notice an improvement in nerve pain. ACDF also provides the best opportunity to improve strength or coordination in the setting of preoperative nerve damage (radiculopathy) or spinal cord damage (myelopathy).
The anterior cervical fusion is performed under general anesthesia. The duration of the operation averages two hours. Intraoperative neurologic monitoring may or may not be performed during the procedure to provide further oversight of nerve and spinal cord function.
The procedure starts with a small incision on the front of the neck. Dissection through the tissue requires spreading of the neck muscles, identification, and retraction of the carotid artery and internal jugular vein and other important vascular structures. The trachea and esophagus are retracted the opposite direction to provide the approach corridor to the front of the spine. The disc tissue is removed with the surgical grasping instruments. Bone spurs are removed with small drills and/or bone-biting tools. Once the spinal cord and nerve roots are decompressed, fusion is performed. A bone graft is placed in the interspace (replacing the previously removed disc) utilizing recycled local bone in a spacer, bone bank bone (called allograft), or the patient’s own hip bone (called autograft); all of these are common graft sources. Newer fusion options include PEEK spacers (synthetic) with biologic materials such as bone morphogenic protein or other fusion-stimulating materials such as locally harvested neck bone, synthetic calcium substrate, and bone marrow aspirates. The surgeon usually elects to use screws and a plating system to provide immediate stability and enhance the fusion process.
The wound is closed with absorbable sutures and Dermabond (skin glue). Thus, no sutures or staples need to be removed postoperatively. The surgeon may or may not recommend that the patient wear a rigid collar for several weeks postoperatively.
Some patients are released the same day as the surgery. More typically, the patient would stay one to two days postoperatively depending on the extent of the surgery and the need to monitor any postoperative problems that may arise. A collar is frequently recommended for the first several weeks.
Driving is not recommended for the first week after surgery. Return to a sedentary work environment is typically allowed after one week, but work that involves physical labor may require several months of healing before the patient is allowed to return to work. Sports activities are likewise restricted for the first three months to light activities such as walking, riding an exercise bike, using a treadmill or lifting light weights. We also encourage walking and getting out of bed often after an ACDF to prevent blood clots in the legs (called deep vein thrombosis or “DVT”).
Common symptoms noted in the first few days after surgery include a sore throat, swallow ing problems and hoarseness. Residual pain in the neck, shoulders or arm can be expected for the first several days postoperatively but should gradually improve over time. Oftentimes, immediate pain relief from the preoperative nerve pain is noted as a result of the surgery.
More severe complications could include hematoma, bleeding internally in the neck with possible breathing problems or pressure on the spinal cord that could cause threatening paralysis of the arms and legs. This is a very rare event but would require immediate reoperation. Long-term complications can include non-union of the fusion. Another postoperative long-term complication could be adjacent level disc degeneration or herniation, that might require future neck surgery years after the original neck surgery; again, this is a relatively uncommon event.
In summary, the anterior cervical fusion procedure is most often a highly successful operation with a very low complication risk. Pain relief is the common expected outcome of this surgery with a high percentage success rate.
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