Anterior cervical discectomy and fusion

Anterior Cervical Discectomy and Fusion (ACDF) is a surgical procedure aimed at relieving spinal cord or nerve root pressure in the cervical spine due to vertebral disc herniation or spinal stenosis. The procedure involves removing a damaged disc to relieve pressure on the nerve roots or spinal cord, followed by a fusion of the vertebrae to stabilize the cervical spine.

Indications

ACDF is typically recommended for patients experiencing significant neurological symptoms such as radiculopathy (nerve pain) or myelopathy (spinal cord compression) that have not improved with conservative treatment options. Indications for the surgery include:

• Cervical herniated disc
• Cervical spinal stenosis
• Degenerative disc disease
• Cervical vertebral fracture
• Spondylolisthesis in the cervical spine

Procedure

The ACDF procedure is performed under general anesthesia. The steps include:

1. An incision is made in the front of the neck.
2. The muscles and tissues are carefully moved aside to expose the cervical spine.
3. The damaged disc is removed, relieving pressure on the nerves or spinal cord.
4. A bone graft or a metal or plastic implant is placed in the disc space to promote fusion between the adjacent vertebrae.
5. The vertebrae may be fixed with metal plates and screws to stabilize the spine while the bone graft heals and fusion occurs.

Recovery

Post-operative recovery varies among patients, but generally includes:

• Pain management with medications
• Wearing a neck brace
• Physical therapy to improve neck strength and flexibility
• Restrictions on heavy lifting and strenuous activities

Most patients can return to normal activities within 4 to 6 weeks, although complete fusion can take several months.

Risks and Complications

As with any surgical procedure, ACDF carries risks, including:

• Infection
• Bleeding
• Damage to the nerves or spinal cord
• Difficulty swallowing or hoarseness
• Non-union of the fused vertebrae (pseudarthrosis)
• Need for additional surgery

Outcomes

Studies have shown that ACDF can provide significant improvement in symptoms for patients with nerve root or spinal cord compression. However, outcomes can vary based on the severity of the pre-operative condition, the presence of coexisting spinal issues, and the patient's overall health.

See Also

• Spinal fusion
• Cervical vertebrae
• Neurosurgery