Anterior cervical discectomy with fusion (ACDF) is a common surgery to relieve nerve and spinal cord compression in the neck. During the ACDF procedure, one or more dysfunctional discs are removed, and then two or more vertebrae are stabilized and fused together. While ACDF surgery is a relatively safe procedure that usually achieves long-term success, the recovery process can vary greatly from person to person.

Common ACDF Recovery Challenges

In order to achieve the long-term benefits of ACDF surgery, most patients understand that the recovery period will entail some short-term inconveniences, such as discomfort, fatigue, and reduced activity levels that typically last anywhere from a few weeks to a few months. In addition, almost all patients will experience at least some challenges with one or more of the following while recovering from an ACDF:

  • Pain that moves around. Some patients are surprised that the most bothersome pain immediately following ACDF surgery may not be in the neck but rather in the upper back and shoulders (due to the fusion altering the attached muscles’ biomechanics) or in the hip (if bone graft was taken from there). In addition, arm pain and tingling may not immediately go away, and in some cases may feel worse before it feels better.
  • Swallowing. Immediately after the surgery, the patient will need to be on a liquid diet for a day or two and slowly work in soft foods, such as applesauce. See After ACDF: Trouble with Swallowing
  • Speaking. Most patients have issues with hoarseness and coughing the first few days after surgery. In some cases, a patient may not be able to speak at all or speak above a whisper for days or weeks after the surgery. See After ACDF: Trouble with Speaking
  • Mental health. The challenges of an ACDF recovery can add up over time and lead to struggles with depression, anxiety, and other mental health issues. In some cases, pain medication side effects can also affect mood and the ability to think clearly. See After ACDF: Managing Mental Health
  • Bowel movements. Constipation can occur in patients recovering from ACDF for a variety of reasons, such as a side effect of opioid medication and/or a lack of exercise and fiber. See After ACDF: How to Prevent or Manage Constipation

This is not a complete list of ACDF recovery challenges. While most of these issues can be successfully managed or pass on their own, it helps to know they might occur and to monitor them in case symptoms worsen.

Read more about ACDF Surgery Postoperative Care


When an ACDF Recovery Setback Is Serious

Having good days and bad days during the recovery period is normal. A painful flare-up or a previously unnoticed symptom is not necessarily cause for alarm. However, medical attention is needed if one or more of the following symptoms occur:

  • Fever of at least 101 degrees
  • Breathing difficulty
  • Worsening of the incision site’s pain, redness, or discharge
  • Swallowing becomes more difficult
  • Voice seemingly getting worse, not better
  • Feelings of sadness or nervousness that are almost constant
  • Constipation that is not relieved with self-care

See Potential Risks and Complications of ACDF Surgery


This is not a complete list of symptoms that may or may not point to a serious issue. Several others could exist, including a worsening of arm weakness or problems with walking or coordination.

Dr. Joshua Shatsky is an orthopedic surgeon for CHI Franciscan Health, where he specializes in spine surgery for trauma and deformities. Dr. Shatsky is an active researcher on spinal pathologies and advanced treatments.