What Is Anterior Cervical Discectomy and Fusion?
Anterior cervical discectomy and fusion (ACDF) is a procedure that aims to relieve certain types of pinched nerve symptoms. Between the vertebrae in the spinal column are intervertebral discs that act as shock absorbers. When these discs degenerate—often due to injury or age-related wear-and-tear—the soft inner section of the disc can punch through the outer layer and press on a nerve, leading to symptoms such as pain, numbness and tingling.
ACDF is a two-part procedure aimed at alleviating these symptoms originating from the neck, also known as the cervical spine. First, the bulging disc is removed to release pressure on the nerve, a procedure called discectomy or microdiscectomy (named for the magnifying glasses that act like microscopes the surgeon may wear during the procedure). Then, the vertebrae above and below the removed disc are joined together—fused—to prevent movement and pain.
Common Reasons for ACDF
ACDF may be necessary in cases of:
- Bone infection (osteomyelitis)
- Cervical spine trauma
- Myelopathy (severe compression of the spinal cord)
- Pinched nerve
- Spinal stenosis
- Vertebral tumors
Candidates for ACDF
People who are good candidates for ACDF surgery usually have:
- Pain, numbness, weakness or tingling in one or both arms
- Tried more conservative measures without success
- Visible signs of disc damage, herniation or stenosis on an imaging study
Preoperative Considerations for ACDF Surgery
One of the most important considerations before surgery is the patient’s nicotine use or willingness to quit smoking before the surgery. It is thought that smoking decreased the effectiveness of fusion surgery and increases the risk of complications. The patient is recommended to stop smoking at least four weeks prior to surgery.
It is also best to avoid nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen after ACDF surgery. NSAIDs slow the healing process of bone and may make the fusion part of the surgery less likely to be successful.
ACDF Surgery Procedure
There are two parts to ACDF: the discectomy and the fusion. First, an incision is made in the front of the neck (anterior means “front”) near the windpipe. The muscles and arteries are moved to the side and the bulging disc is removed, along with any bone spurs. This eliminates pressure on any nerves that were causing pain, numbness, tingling or weakness.
Next, the vertebrae above and below the removed disc are fused together. The surgeon places a piece of bone, either from the patient’s pelvis or from a donor, between the two vertebrae. This is known as a graft. The graft allows the body to overlay more bone on top of the graft, effectively causing the two vertebrae to grow together. This provides extra strength and structure to the neck and spine.
ACDF Surgery Recovery
The surgery has a high rate of success. Almost everyone who has ACDF surgery to alleviate pain in the arm reports less pain, as do three quarters or more of patients who have the surgery to relieve neck pain.
ACDF surgery is usually outpatient, meaning patients can go home within 24 hours. Normal activities can be resumed in four to six weeks.
Patients should avoid NSAIDs well after the surgery, and also avoid lifting, smoking, drinking alcohol, moving the neck up and down, driving, strenuous exercise and sexual contact until their doctor clears those activities.
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