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Anterior Cervical Discectomy and Fusion (ACDF)

What does “ACDF” mean?

Here is what each word means:

  1. Anterior: Surgery is done from the front of the spine, i.e. from the front of the neck
  2. Cervical: area of the spine located in the neck
  3. Decompression: This means that pressure is taken off something. In this case, the pressure on a spinal nerve or spinal cord is removed when the disc is removed. This is called a “decompression”
  4. Fusion: The term “fusion” means that two or more vertebrae are mended together.

Altogether, “Anterior Cervical Decompression and Fusion” means to remove the compression of a spinal nerve or spinal cord from the front of the spine. This is then followed by mending the vertebrae in this area together.

What is an Anterior Cervical Decompression and Fusion (ACDF)?

 

  1. An ACDF surgery is an operation which removes a diseased disc in the neck (cervical spine). The surgery is done from the front (anterior) of the spine rather than from the back (posterior) of the spine.
  2. After the disc is removed, a piece of bone or a material which acts like bone (bone substitute), is put in its place.
  3. Finally, a small titanium plate is screwed into the vertebra above and below the piece of bone. This gives the spine stability and protects the new bone or bone-like material. The bone used for the surgery can be the patient’s own bone, bone from a cadaver, or material which is “bone-like”. This depends on the surgeon’s preference. This segment of the spine can now fuse together to become on large vertebra, rather than two vertebrae separated by a disc.

Why is an Anterior Cervical Decompression and Fusion (ACDF) done?

An ACDF is done for a diseased disc in the neck which is putting pressure on spinal nerves or the spinal cord.

  1. The first goal of the surgery is remove this pressure by removing the disc. When the pressure is removed, the inflammation and pain can stop. In the neck (cervical spine), essentially the entire disc is removed during this surgery. The main reason is that the surgery is done from the front of the spine, whereas the bad part of the disc is on the back part of the spine. So, in order to get to the bad part of the disc, the surgeon has to first remove the front part. This leaves virtually no disc material remaining.
  2. The second goal of the surgery is to protect the spinal nerves and spinal cord from further damage. Since the disc is removed, the same problem cannot happen again.
  3. The third goal of the surgery is to have the bones fuse together. The vertebra above and below where the disc was originally located should fuse to the new bone or bone-like material so that everything is now one large vertebra, rather than two vertebrae separated by a disc.

What is the difference between an Anterior Cervical Decompression and Fusion and other forms of Cervical Discectomies?

Percutaneous and Endoscopic Cervical Discectomies typically require that the disc itself is salvageable. This means, that even though the disc is diseased by a disc herniation, the disc as a whole can still function as a shock absorber once the herniation is removed. An Anterior Cervical Discectomy and Fusion (ACDF) removes the entire disc since the disc is deemed non-salvageable.

  1. An Anterior Cervical Endoscopic Discectomy is done from the front of the spine. It is a minimally invasive spine surgery which removes disc material from a protruding or herniated disc in the neck. It uses a small endoscope to see inside the disc and small graspers (forceps) placed through the endoscope to remove the disc material.
  2. A Cervical Percutaneous Discectomy is done through a needle placed into the disc from the front of the spine. This procedure uses a small needle like device (e.g. nucleoplasty wand) to remove disc material with the help of an X-Ray machine. It does not remove much disc material and does not put anything into the disc.
  3. A Cervical Endoscopic Discectomy is done from the back of the spine. Tubes are placed into the spine to gain access to the disc and requires removing a small portion of bone (laminotomy) in the process. It is a minimally invasive procedure which uses small instruments to remove a piece of disc. This procedure can remove more disc material than a Cervical Percutaneous Discectomy. The disc can also be seen with the endoscope.
  4. An Anterior Cervical Discectomy and Fusion (ACDF) is an open surgery, not minimally invasive. It is done from the front of the spine. An incision and dissection is required (dividing tissue to see the next structure below). An ACDF surgery removes most of the disc and then places bone or bone-like material into the space to allow it to fuse together (become one piece of bone).

How is the surgery actually done?

Here are some of the steps of the surgery:

  1. An intravenous catheter (IV) is placed and antibiotics are given.
  2. This surgery is done in an Operating Room.
  3. The patient is placed on their back (supine) on the operating room table.
  4. The Anesthesia provider puts the patient to sleep under General Anesthesia.
  5. The head and neck of the patient are often secured to avoid any movement during surgery.
  6. The front and sides of the neck are cleaned with a surgical antiseptic and plastic covers (drapes) are placed around the area where the cut (incision) will be made.
  7. Often a small metal device is placed on the neck and an X-Ray is taken. This helps the surgeon to find out where exactly the cut (incision) should be made. The X-Ray will show the metal device and over which disc or vertebra it is located.
  8. A cut (incision) is made through the skin with a surgical knife.
  9. The first structure under the skin is the platysma muscle. This muscle is carefully separated so that the deeper structures in the neck can be seen.
  10. Next, the neck fascia can be seen. Fascia is a layer of thin but tough material which separates different structures. This fascia surrounds muscles, blood vessels, organs, etc.
  11. The fascia is also separated to see the structures below it.
  12. The group of deeper muscles (strap muscles) of the neck are pushed off to one side. A surgical retractor is used for this. Retractors are like “rakes” which are used to gently push structures out of the way so the surgeon can locate and see what is underneath.
  13. The swallowing tube (esophagus) is located and pushed off to the other side.
  14. The front of the neck (cervical spine) can now be seen.
  15. A disc is identified and a small needle is put into the disc.
  16. An X-Ray is taken from the side. The disc with the needle in it can be seen. The discs are now numbered to make sure that the correct disc has the needle in it.
  17. The disc is now removed with a knife and several other surgical tools. This is the most delicate part of the surgery. The surgeon has to be careful to remove all the parts of the disc which can cause a problem.
  18. Two small metal pins are place into the vertebra above and below the disc.
  19. A spreader is connected to the pins. The pins are spread to “open” or widen the space where the disc was.
  20. The part of the vertebrae above and below the disc which are facing it (endplates) are prepared for the bone implant.
  21. The space where the disc was located is measured to make sure the right size of implant is chosen.
  22. The bone or bone-like material is now placed into the space where the disc was previously located (disc space).
  23. An X-Ray is taken to make sure the bone implant looks appropriate in its size and the location.
  24. A small titanium plate is chosen which fits over the new bone. This plate has to be large enough to also cover parts of the vertebrae above and below the new bone.
  25. The titanium plate is placed over the new bone and secured with small screws into the vertebrae above and below.
  26. Another X-Ray is taken to see the “fit” of the plate and screws.
  27. The main part of the surgery is now done.
  28. The pins in the vertebrae are removed.
  29. The retractors are removed
  30. Sometimes a drainage tube (surgical drain) is placed above the plate to allow for any bleeding to drain out from the patient.
  31. The platysma muscle is sometimes closed with stitches (sutures).
  32. The skin is closed with small stitches (sutures).
  33. Sometimes steri-strips (butterflies) are placed over the stitches.
  34. A bandage (dressing) is placed over the wound and taped down.
  35. The patient is awoken from Anesthesia and taken to the Recovery Room.
  36. Often another X-Ray is taken in the Recovery Room to confirm the same position of the implants.

How long does an ACDF surgery like this take?

An ACDF for one disc takes approximately 45 minutes to 2 hours to complete.

What is the recovery from an ACDF surgery like?

1. Patients who undergo an ACDF surgery can either be sent home the same day (outpatient) or be admitted to the hospital.

2. The recovery time is usually 4-6 weeks.

3. A neck brace is sometimes recommended. There are soft and firm (hard) braces. The use of braces depends on the surgeon’s preference.

4. The movement in your neck is typically restricted. For instance, the surgeon may ask you not to look all the way up or down for a period of time.

5. The surgeon will often restrict the amount of weight you can lift. This is done to avoid too much stress on the area of the surgery.

6. You may be asked to avoid taking anti-inflammatory medication (NSAIDS), as they can interfere with the fusion.

7. You may be asked not to smoke or be around Tabaco smoke for a period of time as nicotine interferes with fusions.

8. The surgeon will typically take another X-Ray in a few weeks after surgery to make sure the bone graft and metal plates and screws are in a good position. This will be repeated at certain intervals to see how the fusion is coming along.

9. Sometimes Physical Therapy (PT) is used to help with the neck mobility.

9. It may take 6 months to 1 year for a bone fusion to be solid. This does not mean that a patient will have pain or be limited in their mobility during this time.

10. The symptoms from the disc herniation (pain, numbness, weakness) usually improve quickly but can take weeks to months to complete healing to the maximum level of improvement.

What type of benefit can patients gain from an ACDF surgery?

Patients can get relief of neck and arm pain from a cervical disc herniation or degeneration. This benefit can be for the long term.