Told you need neck surgery? Let me explain what the patient can expect from an anterior
cervical discectomy and fusion, commonly referred to as ACDF.
We'll begin with breaking down the name: Anterior Cervical Discectomy and Fusion.
Anterior refers to the direction in which the surgeon approaches the patient's body, and
cervical refers to the location where the surgery is conducted. In other words, the surgeon makes an
incision in the front (anterior) neck (cervical). The incision is not only skin deep. Care is taken
to safely dissect between various muscle plains and avoid damage to other important structures.
The esophagus, trachea, and major arteries and veins are carefully retracted, allowing the
surgeon to visualize the targeted spine area.. Discectomy refers to the removal of the herniated
disc material. Once the surgeon has reached the bones of the neck and located the targeted disc,
the disc material is removed. Without the pressure from the herniated disc, the surrounding
tissues -- such as the thecal sac, spinal nerves, and spinal cord -- are no longer irritated.
Any compressing bone spurs are also removed at this stage.
Now, fusion, as the name implies, refers to the formation of a single bone from what was
originally two vertebrae. The bone edges are scraped clear of soft tissue and contoured
appropriately to accept the bone graft or cage that is placed into the empty space that contained
the removed disc. The bone or cage then heals together to complete the fusion process. Care
must be taken to select the appropriately sized graft or cage to fit into the disc space. Usually , a
combination of plates and screws provide stability while the bone grows into the graft.
Upon graft completion the surgeon returns all the structures to their proper place and the incision
is closed. A cervical collar may be recommended depending on the patient and the intensity of
the procedure. As expected, certain activities may be restricted while your body recovers from
the operation. Specific questions and individual concerns should be discussed with your surgeon.
Why should I get an anterior cervical discectomy and fusion?
It is the preferred surgical intervention for symptomatic cervical spine herniations or
bone spurs that compress the spinal cord or nerves.
The most well-studied and well-established causes for ACDF are radiculopathy, and myelopathy.
Those with radiculopathy caused from a pinched nerve are often able to improve with non-surgical
treatment. One study shows that most patients show improvement in their symptoms without surgery within 4 to 6 months.
The presence of a significant spinal cord compression or myelopathy,
can be a reason for pursuing surgery.
As emphasized in my prior videos, ACDF should only be considered when all non-surgical
or conservative treatments have been exhausted.
What are the Concerns?
Upon the surgeon's confirmation of the diagnosis by clinical findings,
a surgical intervention should be considered. Severe symptoms
of myelopathy are more than numbness and radiating pains in the dermatomal distribution.
If there are severe weakness of the legs, or inability to control your bladder and bowels,
you must be evaluated immediately. What are the current research?
Studies have shown the efficacy of an alternative surgery which is Cervical Disc Arthroplasty
or Disc Replacement Procedure. It may preserve cervical motion and potentially reduces the risk
of adjacent segment degeneration compared to standard Anterior Cervical Discectomy and Fusion.
Additionally, non-fusion alternatives are available
and are preferred in some scenarios. Currently, research is being aimed at improving fusion
with 3D printing. The goal being to improve patient outcomes.
For a long time, ACDF has and still remains the standard surgical intervention for
managing symptomatic disc herniations. Despite boasting a relatively high success rate and low
complication rate, it does have room to improve. New technological advancements may result in
even better surgical techniques and better patient outcomes.
I hope this video broadened your understanding of ACDF. Until next time, this is Dr. John Shim.