Anterior Cervical Discectomy and Fusion (ACDF) Surgery
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What is ACDF Surgery?
ACDF is a surgical procedure used to treat various conditions that place pressure on the nerves or spinal cord, which can cause pain, discomfort, and other symptoms. It usually involve the removal of a herniated or degenerative disk from between two vertebrae in the cervical spine, which supports the head and protects the spinal cord. A bone graft is then placed in the space where the disk was removed, bridging the two vertebrae. The vertebrae are then held in place with metal plates and screws, allowing new bone cells to grow around the graft and form a single, solid bone piece. Recent technique uses demineralised bone matrix packed in stand alone cervical cage which negates the use of bone graft.
Your doctor may recommend ACDF surgery to help relieve pressure on the nerves or spinal cord, as well as manage conditions such as arthritis, which may affect your quality of life.
What Does ACDF Surgery Treat?
You may be suitable for ACDF surgery if you are experiencing any of the following symptoms or conditions.
Herniated Disk
A herniated, or bulging, disk occurs when the inner layer of the intervertebral disk, the nucleus, leaks out from the tougher, rubbery exterior, the annulus. This may happen due to injury, gradual wear and tear, or degenerative conditions. When the nucleus leaks, it can impinge on nearby spinal nerves or the spinal cord, potentially leading to pain and numbness. ACDF surgery treats this by removing the herniated disk and inserting a graft in its place to facilitate spinal fusion.
Degenerative Disk
This condition is characterised by wear and tear on the intervertebral disk. When this occurs, it causes the bones to rub against each other, wearing out the disk’s ability to absorb shocks and support the spinal column. As a result, this can potentially lead to herniated disks. ACDF treats this condition similarly to treating a herniated disk, which means removing the damaged disk and installing a graft.
Cervical Stenosis
This condition occurs when the spaces within the spinal canal, which contain your spinal cord, gradually narrow. When this happens, it can press on the nerves and cause symptoms such as back pain and sciatica. ACDF surgery may be performed to remove bone spurs that are impinging on nerves or to open the space in the spinal canal, thereby reducing pressure on the nerves.
ACDF Surgery Procedures
Before the surgery, your doctor will explain what you can expect from the ACDF surgery, including procedure details and general recovery outcomes. You may need to fast for several hours before the surgery and avoid taking certain medications as instructed by the doctor. Additional pre-surgery instructions may be given depending on your general health and other concerns.
If you require a bone graft for cervical fusion, your doctor may choose to source the graft from another part of your body (autograft) or from a donor (allograft). This process will require specific preparations depending on where the graft is sourced. Before ACDF surgery, a minor surgical procedure may be needed to retrieve bone for use as a graft.
On the day of the surgery, an anaesthesiologist will administer general anaesthesia to ensure you do not feel pain during the procedure. Once the anaesthesia takes effect, the surgeon will make a small incision at the front of your neck to reach the cervical spine. Structures such as the trachea, oesophagus, and nearby blood vessels will be carefully moved aside.
With the cervical spine accessible, the surgeon will use a fluoroscope to determine the location of the disk. A fluoroscope utilises special contrast dye and X-rays to clearly visualise the various structures in your body. In ACDF, it helps guide the surgeon to identify the herniated or damaged disk, along with any bone spurs they find, and then remove them carefully. If necessary, the surgeon will also perform a foraminotomy to widen the spinal canal and prevent nerve compression.
The surgeon then positions the graft into place. If an autograft is used, the graft is taken from your hip bone and shaped to fit the area where the damaged disk was located. The graft site will need to be prepared to expose the blood-rich cancellous bone to ensure the fusion proceeds with minimal complications. Once the graft is in position, the surgeon will hold it in place (along with the neighbouring vertebrae) using metal plates and screws, then use an X-ray to verify its position.
After the procedure, the surgeon will close the surgical incision with sutures. You will then be taken to the recovery area for further observation before returning to the ward.
Who is Suitable for ACDF Surgery?
You may be eligible for ACDF surgery if you are still experiencing the following symptoms, even if you are currently receiving nonsurgical treatments to alleviate these symptoms.
- Radiating pain in the arms
- Frequent tingling or numbness
- Persistent, or severe, neck pain
- Difficulties moving your arms, hands, shoulders, or neck
- Problems maintaining balance or walking without support
Frequently Asked Questions
Will ACDF surgery affect my neck’s flexibility?
In ACDF surgery, the fusion procedure may limit the flexibility of the neck vertebrae that were fused with the graft. However, most people do not notice any significant changes to their neck’s overall flexibility after recovery.
How long does it take to recover from ACDF surgery?
It may take between six months and a year for the fused vertebrae to solidify and minimise the risk of complications. A surgical neck brace will be provided to support your recovery, along with post-surgery care instructions from your doctor. With follow-up checks and lifestyle adjustments, you may be able to sit up and walk within several weeks. You may also need to limit physical activities for the next few months to ensure your recovery proceeds smoothly.
Does ACDF surgery have any risks?
General complications due to ACDF surgery may include bleeding, infection, and blood clots. Specific complications may include temporary hoarseness when you talk, bone graft migration during neck movements, and persistent nerve-related pain. Your surgeon will take measures to minimise these risks during the procedure.
Related Treatments
A low-grade ACL injury can be managed without surgery, but severe injuries like a torn ACL require surgery to properly treat the resultant knee instability.
Cervical spine fusion is a surgical procedure to treat conditions affecting the vertebrae in your cervical spine. The procedure involves fusing two vertebrae to form a single, solid bone, thereby treating damage to the vertebrae and supporting the stability and flexibility of the cervical spine. Cervical spine fusion can be performed using several approaches, informed by the nature of the injury or degeneration. Recovery typically takes between six months and a year for the fused bone to solidify. Proper care is necessary to facilitate recovery and minimise the risk of complications.
