As with any surgery, there are a number of possible risks and complications of anterior cervical discectomy surgery, or ACDF.

The rate of occurrence of potential risks and complications is variable and dependent mainly on a combination of the following factors:

  1. The results of the individual surgeon with ACDF surgery (meaning that the frequency of complications varies between surgeons), and;
  2. Individual patient risk factors, such as the condition of the disc, the patient’s physical condition (bone strength, diabetes, etc.), whether or not the patient smokes, and other factors.

Potential Risks and Complications of ACDF Surgery

For an ACDF surgery, the main potential risks and complications that tend to occur include:

  • Inadequate symptom relief after the surgery
  • Failure of bone graft healing to create a fusion (a non-union, or pseudarthrosis)
  • Temporary or persistent swallowing (medically known as dysphasia)
  • Potential speech disturbance from injury to recurrent laryngeal nerve that supplies the vocal cords. See After ACDF: Trouble with Speaking
  • Dural tear, or spinal fluid leak
  • Nerve root damage
  • Damage to the spinal cord (about 1 in 10,000)
  • Bleeding, major blood vessel injury
  • Infection
  • Damage to the trachea/esophagus.
  • Hematoma or seroma causing airway compromise.

By far the most common complication following surgery is difficulty with swallowing, medically known as dysphagia. The esophagus lies directly in front of the spine and needs to be mobilized and retracted during surgery, which can cause difficulty swallowing. The dysphagia usually resolves within days, but there is a risk that it can last weeks to months. There is a rare risk that dysphagia will be permanent.

See After ACDF: Trouble with Swallowing


There is also a chance of developing symptoms at of the disc levels either above or below the fused vertebrae, termed Adjacent Segment Disease (ASD). It has been estimated that about ¼ of patients will have symptoms from problems at an adjacent disc by 10 years after surgery. It is still unknown whether having a fusion surgery, with the resulting loss of motion between the vertebrae, contributes to the faster disc degeneration above and below the fusion. Alternatively, the same factors that caused the problems at the disc(s) that required surgery may have ultimately impacted the other discs as well. More research is needed to fully understand all of the risk factors involved so that this can better be prevented in the future.


Unlike a microdiscectomy for treatment of a lumbar disc herniation, with an ACDF there is little chance of a recurrent disc herniation because the disc is removed. If symptoms develop from the same disc level following surgery, it is usually because the bones did not successfully heal together—which is called a nonunion or pseudarthrosis. This may require either a revision anterior surgery or a surgery done through the back of the neck, in an attempt to get the bones to heal together or “fuse” solidly.

See Spine Fusion Risks and Complications

This article does not include a complete list of all potential risks and complications: as with all surgeries, it is advisable to fully review the potential risks and complications with the treating surgeon prior to having ACDF surgery.

See Specific Questions to Ask Your Spine Surgeon

Dr. Kevin O’Neill is an orthopedic surgeon at OrthoIndy Hospital, where he specializes in spine surgery and cervical spine conditions. He has presented research at many national meetings and authored numerous articles in medical journals.