ACDF Surgery Procedure

The general procedure for an anterior cervical discectomy and fusion—or ACDF—surgery includes the following steps:

  1. Anterior surgical approach
    • The skin incision is one to two inches and horizontal, and is be made on the left or right hand side of the neck.
    • The thin platysma muscle under the skin is then split in line with the skin incision, and the plane between the sternocleidomastoid muscle and the strap muscles is then entered.
    • Next, a plane between the trachea/esophagus and the carotid sheath can be entered.
    • A thin fascia (flat layers of fibrous tissue) covers the spine (pre-vertebral fascia), which is dissected away from the disc space.
  2. Disc removal
    • A needle is then inserted into the disc space, and an X-ray is done to confirm that the spine surgeon is at the correct level of the spine.
    • After the correct disc space has been identified on X-ray, the appropriate portions of the disc are then removed by first cutting the outer annulus fibrosis (fibrous ring around the disc) and removing the nucleus pulposus (the soft inner core of the disc).
    • With an anterior cervical discectomy, most of the disc (but not all) is usually removed.
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  1. Canal Decompression
    • Dissection is carried out from the front to back of a ligament called the posterior longitudinal ligament.
    • Often this ligament is gently removed to allow access to the spinal canal to remove any osteophytes (bone spurs) or disc material that may have extruded through the ligament, which may be part of spinal stenosis or osteoarthritis.
    • The dissection is often performed using an operating microscope or magnifying loupes to aid with visualization of the smaller anatomic structures.
  1. Cervical Fusion
    • An anterior cervical fusion is almost always done as part of a cervical discectomy. The insertion of a bone graft into the evacuated disc space serves to prevent disc space collapse and promote a growing together of the two vertebrae into a single unit, with this "fusion" preventing local deformity (kyphosis) and serving to maintain adequate room for the nerve roots and spinal cord.
    • Once the cervical fusion heals together, one solid bone is formed in the space where the disc used to be.

Patients typically go home the same day as the anterior cervical discectomy and fusion or after one night in the hospital. Most patients recover within about 4 to 6 weeks, although it may take up to 18 months for the fusion to fully set up.

Patients should discuss relevant activity restrictions and rehabilitation with their surgeon.