Anterior Cervical Discectomy Fusion (ACDF)

Anterior Cervical Discectomy and Fusion is a specialized surgery that involves the removal of the discs (degenerative or herniated) in the cervical part of the spine (neck region) followed by the fusion of the affected vertebras. ACDF can be performed on two or more vertebras of the cervical region. Dissection of discs or spurs gives more space for the nerves leading to decompression and fusion offers stabilization to the cervical part of the spine. ACDF is indicated in the treatment of herniated discs which has led to weakness, loss of sensation, tingling, or severe neck/arm pain.

Alternate Name

Anterior cervical decompression

Body Location

The cervical part of the spine (neck region)

How Performed

ACDF is carried out by an orthopedic surgeon or a neurosurgeon under general anesthesia and you will be asleep throughout the procedure unable to feel any pain or sensation. The spine is accessed via the anterior side (front of the neck) to avoid any injury to the sensitive spinal cord, nerves, and neck muscles. In minimally invasive surgery a small incision is made and the soft tissues such as the trachea, and esophagus are moved aside to access the spine vertebras.

Under an operating microscope,specialized surgical instruments are inserted through the incision to assist the surgeon to target the specific bones without disturbing other organs, bones, and tissues. The surgeon removes the herniated or damaged discleading to the creation of a gap between the vertebras. A graft will be used to seal the gap and fuse the vertebras and it could be taken from your pelvic bone, from a bone bank, or a synthetic material could be used. The graft stimulates the fusion of vertebras and the surgeon will use screws to hold the bones together for enhanced stability and a better success rate. The incisions will be stitched afterward.

Preparation

During ADCF surgery, you will undergo certain blood tests such as CBC (complete blood count), bleeding test, clotting test, etc. You will also undergo a pre-anesthesia check-up (PAC) including an electrocardiogram (ECG) and a chest X-ray that will be evaluated by a doctor to deem you fit for the surgery. You will be referred to take imaging tests such as an X-ray, fluoroscope (a specialized X-ray), MRI scan, or CT scan as your surgeon will confirm the diagnosis, mark the location of pain, and plan the surgery.

Inform your doctor about your current medical conditions, medical history, and use of any medications. You need to discontinue blood thinner medications such as warfarin or aspirin to avoid the risk of bleeding. Stop drinking and smoking as these could hinder the healing process.

Do not drink or eat anything after midnight on the day before the operation as it can complicate the situation when you are given anesthesia..

Procedure Type

Minimally invasive

Follow-up

You will be given a follow-up schedule and you should follow up with your surgeon as per the plan to ensure a healthy recovery. You might also be undergoing an MRI scan or CT scan at certain follow-ups after the surgery as your surgeon will assess the recovery progress. You might also be advised to undergo physiotherapy for a few weeks to restore your movements and help you gain flexibility.

You should start with light physical activity such as walking as suggested by your doctor. Avoid heavy activities such as cycling, running, jogging, lifting weights, etc. that could strain your neck. During recovery, don’t overexert yourself and take help from your family members and friends to perform your daily activities. Avoid long road trips and driving for a few weeks while you are recovering and if it is required, discuss it with your surgeon. Keep the incision clean by washing it and keeping it dry.

Risks

Though the surgery is extremely safe, rarely it can have the following complications

• Incision site infection could occur and you might require antibiotic treatment.
• Hypersensitivity to anesthesia and other drugs could occur in sensitive individuals.
• Bleeding at the incision site could occur in certain complex cases.
• Damage to the adjoining or nearby organs/tissues/nerves could lead to other painful conditions or loss of sensitivity.
• Difficulty in swallowing is common for a few days following the surgery.
• Speech disturbances may occur due to damage to the vocal cords.
• In some cases, symptoms could recur due to certain reasons such as overall cervical part of the spine weakness or instability of the cervical region.
• Pseudarthrosis could occur due to incomplete bone fusion and individuals with diabetes, tobacco use, smoking, advanced age, etc. are more prone to develop it.

Recovery

After the surgery, you will be under intense monitoring for a couple of hours to days, depending upon the complexity of the surgery and your overall health status. You will be discharged within a day or two once you have stable parameters. You will be given training for moving, standing, and sitting so that you don’t put pressure on your neck. Avoid whiplash or quick neck movements while the fusion process is underway during the initial months.

A complete recovery may take from around 6-8 weeks and while you return to your routine activities, you need to take good care of your neck area. Wear cervical support belts as recommended by your doctor for a specified duration. You should not indulge in any heavy activity for a few weeks and must discuss with your doctor if your job requires lifting heavy weights or strenuous physical activity. Eat a healthy and balanced diet, which is rich in proteins and nutrients to speed up recovery. Take your pain medications as advised by your surgeon and avoid self-medication. Always look for warning signs and in case of sudden pain or other complications, seek immediate medical care.