Anterior Cervical Discectomy and Fusion (ACDF)

skeletal view of Anterior Cervical Disectomy highlighted in green

Anterior cervical discectomy and fusion or ACDF, is a surgery designed to relieve spinal cord or nerve root pressure in the neck by removing all or part of a damaged disc:

  • This procedure starts with a one- to two-inch incision in the front of the neck. Dr. Osborn typically operates from the right side of the patient.
  • The thin layer of platysma muscle that lies under the skin is cut and moved aside. Typically, this is the only muscle that is cut during an ACDF (and accounts for the relatively painless nature of the procedure).
  • The pre-vertebral fascia, a thin layer of fibrous tissue that encases the spine, is dissected away, exposing the target intervertebral disc(s).
  • An incision is made in the outer coating of the disc, called the annulus fibrosus, and the soft inner core of the disc, called the nucleus pulposus, is removed.
  • Most of the damaged disc is extracted under microscopic visualization.
  • The posterior longitudinal ligament (PLL) is typically removed to access the spinal canal so the surgeon can remove any bone spurs or disc material that may have extruded through the ligament.
  • Next, the anterior cervical fusion is performed, in which a bone graft or a cage is inserted into the space where the disc used to be.
  • The fusion serves to prevent the disc space from collapsing and allows the bone to grow together to set up a bony bridge, or fusion, between the upper and lower vertebrae.
  • A small metal plate is typically affixed to the front of the upper and lower vertebrae to provide stability while the bone fusion heals together, a process that typically occurs within 3-6 months, if not sooner.
  • Patients typically are discharged home after an overnight stay in the hospital.

xray of screws in an Anterior Cervical Disectomy

WHAT YOU WANT TO KNOW

“Neck surgery? That seems dangerous. Is it?”

The thought of an incision being made in your neck can be daunting. That said, major complications are infrequent. Postop paralysis for example is extremely rare. The most common phenomenon is hoarseness which typically resolves in 7-10 days. During that period of time, one must take appropriate precautions while eating and drinking. Other procedure risks include but are not limited to the following:

  • Hemorrhage or formation of a wound hematoma.
  • Damage to the carotid or vertebral artery resulting in a stroke or excessive bleeding, even death.
  • Recurrent laryngeal nerve injury resulting in long-lasting or even permanent hoarseness.
  • Damage to the superior laryngeal nerve resulting in swallowing disturbance.
  • Damage to the esophagus or trachea resulting in infection.
  • Damage to the dura, resulting in a cerebrospinal fluid leak or pocket of cerebral spinal fluid beneath the incision (pseudomeningocele).
  • Mechanical complications of the graft and plate (including graft migration, breakage of the plate, screw pullout, etc.).
  • Wound infection
  • Development of painful pseudoarthrosis (failure of adequate fusion to occur).
  • Damage to the spinal cord or nerve root(s) resulting in pain, weakness, paralysis, loss of sensation and loss of bowel, bladder and sexual function.
“Will I have to wear a collar after surgery? If so, for how long?”

For single level operations, the fusion rate is very high (> 95%) independent of collar usage. Larger fusion constructs (multilevel) are associated with higher rates of non-union or pseudoarthrosis. Dr. Osborn prefers to utilize collars in this context to better one’s chances of developing a successful bony fusion.

“Will I have neck pain after surgery?”

Anterior cervical fusions are typically performed for radiculopathy (nerve root dysfunction) or myelopathy (spinal cord dysfunction).

The goal is to alleviate pain or neurologic deficit (weakness, sensory loss or bowel/bladder problems). Neck pain, which may or may not be an associated presenting symptom, may improve postoperatively. It may also remain unchanged in the wake of surgery and in a minority of cases, worsen. The latter may prompt additional imaging studies to rule out a pseudoarthrosis. Neck pain is rarely the primary indication for an anterior cervical fusion (barring a corrective procedure for deformity).

“For how long will I be laid up after surgery? When can I return to my normal activities?”

There is minimal downtime after an ACDF. Patients are typically mobilized on the night of surgery and discharged home the following morning. Lifting is restricted to 5 pounds for the first six weeks and thereafter liberalized. Normal activities (including driving) are typically resumed after 6 weeks. Physical therapy (inclusive of strength training) may be prescribed to accelerate recovery.

“Will I have a large scar on my neck?”

No. Anterior cervical fusions are typically performed through an inch-and-a-half incision. The skin is closed with a subcuticular (under the skin) suture or an adhesive to minimize scarring. Dr. Osborn also attempts to conceal the incision in a skin crease in order to better the cosmetic result.

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