The surgery is anterior because the surgeon accesses the disc through the front of the neck, rather than through the back.
What is ACDF surgery?
Diagram of anterior cervical discectomy and fusion surgery.
Image credit: debivort, 2007
Between each bone of the spinal column is a cushion called an invertebral disc. These discs prevent the bones from grinding against one another and act as shock absorbers during falls, exercise, and daily activities.
Sometimes these discs become damaged; causing pain that can range from moderate to intense. An ACDF procedure may be carried out on any of the discs in between the seven cervical bones.
It is easier for the surgeon to reach the spinal column through the throat because entering through the back of the neck can harm the neck muscles and spinal column. The surgeon then moves the tissue inside the neck and throat aside to access the spine and removes any damaged discs.
To ensure that the spine is aligned and to prevent the bones of the spine from rubbing against one another, the surgery typically includes fusion of at least two bones. It is at this point during the procedure that the surgeon replaces the disc.
There are a few options for disc replacement:
- Bone graft: A bone graft is when the surgeon attaches bone to the area to replace the disc. The bone may come from somewhere else in the person’s own body, or from a bone bank.
- Bone graft substitute: Similar to a bone graft, this approach uses human-manufactured materials that contain shavings from the person’s bones.
- Arthroplasty: This is when the surgeon replaces the disc with an artificial disc.
Once the replacement disc is in place, the surgeon uses a titanium plate and screws to attach the bones. When the surgery involves a bone graft, the bones will eventually grow together. Until that happens, the plate and screws provide stability.
An X-ray machine helps the surgeon ensure the replacement disc is in the right place. After the procedure, the surgeon moves the tissue of the neck and throat back to its original location and seals the wound with stitches.
What are the reasons for ACDF surgery?
The discs may thin, dry out, or swell and bulge, resulting in inadequate cushioning. When discs become damaged, this is called degeneration. Discs can also swell or break open, which is called herniation.
Sometimes the pain causes muscle stiffness and soreness. It can also radiate to other areas of the body, causing headaches, back, and shoulder pain.
Alternatives to surgery
Not everyone with damaged discs experiences pain. Most people with damaged discs do not need surgery. Other treatments may help including:
- exercise therapy
- physical therapy
When these treatments fail, and a person’s pain is enough to interfere with daily life, a doctor will assess whether ACDF is likely to help with the pain. People tend to be good candidates for surgery if they:
- have signs of disc damage on an imaging scan
- have pain, weakness, or tingling in the hand or arm
- have neck pain due to pinched spinal nerves
- have tried other treatments but have not improved
What to expect
ACDF will take place under general anestheisa, but as an outpatient.
ACDF is usually an outpatient procedure, which means the individual returns home the same day as surgery. The operation takes place under general anesthesia so the person will be asleep.
After the surgery, most people will experience some pain that they can likely manage with pain medication. Recovery takes several weeks, and some people may need to wear a collar to stabilize the neck.
Most people will meet with a surgeon 4 to 6 weeks following surgery for an assessment and should avoid strenuous activity until cleared by the surgeon.
What are the complications?
As with many other surgeries, the primary risk of ACDF surgery comes from the anesthesia, not the surgery itself. Some people develop respiratory problems due to the combination of anesthesia and their position during the procedure.
The rate of this complication varies between less than 1 in 100 to more than 1 in 10. Very rarely, respiratory problems due to anesthesia can be fatal.
Other potential complications include:
- long-term pain at the location of the bone graft
- infection of the incision made to access the bones, or of any of the tissue affected by the surgery
- infection of the vertebrae
- excessive bleeding
Two extremely rare complications can be fatal if not promptly and effectively treated:
- leakage of the cerebrospinal fluid (CSF) that cushions the spinal cord
- brain infection
ACDF does not always work to reduce pain or restore full mobility. Some individuals might need additional surgeries or other treatments, so people should discuss with their doctors how likely it is that the procedure will work.
Rehabilitation and recovery
Physical therapy may help to reduce pain and restore mobility to the area.
Most people can drive again 1 to 2 weeks after surgery. Most people need 4 to 6 weeks to complete the initial healing process, but this varies according to age, health, and other factors.
After a follow-up with the surgeon, people typically begin physical therapy. This aims to reduce pain and can restore mobility to the area. Some people may fully recover, regaining full range of motion with little or no pain, while others may have chronic stiffness.
An active lifestyle that includes plenty of exercise can aid recovery. However, people should get permission from the surgeon before they start exercising. Some individuals might need to avoid strenuous physical activity to prevent injuries to the neck.
As with all surgeries, ACDF carries some risks. But for most people, the process is relatively uncomplicated and enables a return to a normal life. People should carefully weigh the benefits of surgery against the risks and should consider seeking a second opinion before proceeding with surgery.
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