ACDF: Anterior Cervical Discectomy and Fusion

Anterior cervical discectomy and fusion (ACDF) is a type of neck surgery that involves removing a damaged disc to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness, and tingling. A discectomy is a form of surgical decompression, so the procedure may also be called an anterior cervical decompression.

The surgery has 2 parts:

• Anterior cervical discectomy. The surgery is approached through the anterior, or front, of the cervical spine (neck). The disc is then removed from between two vertebral bones.
• Fusion. A fusion surgery is done at the same time as the discectomy operation in order to stabilize the cervical segment. A fusion involves placing bone graft and/or implants where the disc originally was in order to provide stability and strength to the area.

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 in the neck (osteophytes) caused by arthritis and to alleviate the symptoms associated with cervical spinal stenosis.

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

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 through the back of the neck. This approach has several typical advantages:

• Direct access to the disc. The anterior approach allows direct visualization of the cervical discs, which are usually involved in causing the stenosis, spinal cord or nerve compression, and symptoms. Removal of the discs results in direct nerve and spinal cord decompression. 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, called the C7-T1 level, 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. The patient tends to have less incisional pain from this approach than from a posterior operation.

  See Hospital Care After ACDF Surgery

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.

See Pain Management at Home after ACDF

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.

See Anterior Cervical Discectomy and Fusion Complications

While an ACDF is the most commonly performed operation for treatment of cervical disc pathology, a newer procedure, called a cervical artificial disc replacement, is also available.