ACDF Surgery(Anterior Cervical Discectomy with Fusion)
An ACDF is an anterior cervical discectomy with fusion surgery which involves the removal of the degenerated, herniated, or calcified intervertebral discs and replacing it with a graft or an immobile implant which are locked in place with screws to prevent motion and facilitate fusion. ACDF surgery is only suggested if medications and physical therapy fail to relieve your neck or arm pain caused by pinched nerves.
Indications:
If you have some of the following conditions or symptoms, you may be a person for an ACDF:
Procedure
Before the procedure
- The surgeon will ask about your medical history (previous surgeries, allergies, medicines/vitamins, bleeding history, and anesthetic reactions).
- Tell your doctor about all the medications (prescription, over-the-counter, and herbal supplements) you are taking.
- Presurgical investigations or tests (e.g., blood test, chest X-ray, electrocardiogram, etc.) may need to be done several days before surgery.
- Consult your doctor about stopping certain medications and ensure you are cleared for surgery.
- Stop taking all the non-steroidal anti-inflammatory medications and blood thinners one week before surgery.
- You are advised to quit smoking before the procedure so that you can recover quickly.
- To avoid bleeding and healing problems, stop using nicotine and drinking alcohol one week before the surgery.
- Do not eat or drink after midnight before the day of surgery. You may be permitted to take medicines with a small sip of water.
During the Procedure
Anterior surgical approach:
- The skin incision is made one to two inches on the left or right hand side of the neck. The incision is typically made horizontally within a natural skin crease, though a more vertical incision is occasionally used for multilevel cases.
- The thin muscle beneath the skin is then divided along the skin incision, and the plane between the sternocleidomastoid and strap muscles is entered.
- Then, a plane between the trachea or esophagus and the carotid sheath is entered.
- A thin fascia that covers the spine (prevertebral fascia) is then dissected away from the disc space.
Disc removal:
- Fluoroscopy is used during surgery to provide an x-ray image of the spine to confirm that the surgeon is at the correct disc level.
- The disc is removed once the correct disc space has been identified.
Cervical spine canal decompression:
- During surgery, the surgeon dissects the posterior longitudinal ligament, the ligament that connects the disc with the spinal cord. This allows the surgeon access to the spinal canal so they can remove the disc debris.
- It is also not uncommon for the surgeon to remove a portion of the uncinate processes, which form the disc’s boundaries. To ease the pain caused by spinal cord compression or nerve root compression, the surgeon takes out osteophytes bone spurs from the body. A magnifying loupe or operating microscope lets the surgeon see the smaller anatomical structures during the dissection.
Cervical fusion:
- After the cervical discectomy, an anterior cervical fusion is performed. The insertion of a bone graft or implant into the evacuated disc space helps to prevent the disc space from collapsing and to promote the fusion of the two vertebrae into a single unit.
- Fusion aids in the maintenance of decompression by providing adequate space for the nerve roots and spinal cord, as well as the prevention of local deformity (kyphosis).
- A small plate is attached to the front of the spine with screws inserted into each vertebral bone. This promotes the healing "fusion" process by providing additional stability across the disc space.
- Once the anterior cervical fusion occurs, bone is formed in the space where the disc used to be, uniting the vertebral bones above and below into one solid bone.
After the procedure
- Patients may leave the hospital the same day or the next day after the ACDF surgery. Most patients recover and resume most of their daily activities within 4 to 6 weeks. A full fusion can take 12 to 18 months for the bones to form into one.
- The surgeon should discuss any physical restrictions and rehabilitation options depending on the patient’s health and cervical spine health.
- A neck brace is often recommended up to 8 weeks following surgery.
- Physical therapy, massage, and acupuncture are recommended to strengthen the muscles in the neck.
Patient education:
After your procedure, your doctor will provide instructions to promote a smooth recovery. These guidelines may include do’s and don'ts such as:
| Do’s | Don’ts |
| Wear your neck brace as instructed. | Bend, twist or tilt your back. |
| Manage your pain as directed. | Lift items weigh 10 pounds or more. |
| Maintain a healthy diet and stay hydrated. | Use tobacco products or alcohol. |
| Keep your incision dry. | Participate in physically demanding activities. |
| Get enough sleep and take rest breaks as needed. | Stay sedentary for long periods of time. |
| Attend all follow-up appointments and physical therapy sessions. | Resume activities before you are cleared to do so. |
Benefits and Risks
Benefits
The ACDF surgery has advantages such as
- Relieving neck pain
- Relieving nerve root compression which relieves tingling, pain, and numbness.
- Improve in power which may be reduced by nerve compression.
- Relieve dynamic compression of the spinal cord.
- Improve in finger dexterity which can be caused by cord compression.
- Prevent deterioration
- Improved quality of life
Risks
Generally, ACDF is a safe procedure. Just like any surgical procedure, there are potential risks and complications with ACDF, such as
- Difficulty swallowing
- Hoarse voice
- Decreased motility
- Faster degeneration of surrounding discs
- Blood loss
- Infection
- Nerve damage
- Spinal cord damage
- Failure to relieve symptoms
Care at Medicover
Most people with a herniated disc or degenerative disease can return to normal lives following ACDF surgery. The benefits of undergoing ACDF surgery should be carefully considered against other nonsurgical treatments. Medicover Hospitals offers advanced surgical and medical treatment protocols to patients suffering from spine diseases. Medicover Hospital is recognized for its expertise & experience in the treatment of complex spinal conditions. We have the best spine or neurosurgeons and a dedicated team of staff who bring a wealth of knowledge and diverse expertise that has helped us grow into the best spine surgery hospital in India.
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