ACDF: Anterior Cervical Discectomy and Fusion

A cervical herniated disc can be removed through an anterior approach (through the front of the neck) to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness, and tingling.

  • This procedure is called an anterior cervical discectomy and allows the offending disc to be surgically removed. A discectomy is a form of surgical decompression, so the procedure may also be called an anterior cervical decompression.
  • A fusion surgery is almost always done at the same time as the discectomy in order to stabilize the cervical segment.
  • Together, the combined surgery is commonly referred to as an ACDF surgery, which stands for Anterior Cervical Discectomy and Fusion.

While this surgery is most commonly done to treat a symptomatic cervical herniated disc, it may also be done for cervical degenerative disc disease. It is also commonly done to remove bone spurs (osteophytes) associated with cervical spinal stenosis and arthritis.

ACDF may be done for one level or for more than one level of the cervical spine.

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Anterior Cervical Surgery Approach

An ACDF is done with an anterior approach, which means that the surgery is done through the front of the neck as opposed to the back of the neck. This approach has several typical advantages:

  • Better access to the spine. The anterior approach can provide access to almost the entire cervical spine, from the C2 segment at the top of the neck down to the cervicothoracic junction, which is where the cervical spine joins with the upper spine (thoracic spine).
  • Less postoperative pain. Spine surgeons often prefer this approach because it provides access to the spine through a relatively uncomplicated pathway. All things being equal, the patient tends to have less incisional pain from this approach than from a posterior operation.

After a skin incision is made in the front of the neck, only one thin vestigial muscle needs to be cut, after which anatomic planes can be followed right down to the spine. The limited amount of muscle division or dissection helps to limit postoperative pain following the spine surgery.

While there are a number of potential risks and complications with ACDF surgery, the main postoperative problem most patients face is difficulty swallowing for 2 to 5 days due to retraction of the esophagus during the surgery.

Not all ACDF surgeries are the same—there are a number of options and variables as part of the surgery that can play a role in how successful it is and impact the relative risks and potential complications. Patients are well served to fully understand and discuss the important variables that are part of the ACDF; for example, which or how many levels will be addressed and why, what type of implant will be used and why, and what type of bone graft the surgeon is recommending and why.

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