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Anterior Cervical Discectomy and Fusion

Told you need neck surgery?  Let me explain what the patient can expect from an anterior cervical discectomy and fusion, commonly referred to as ACDF.

We’ll begin with breaking down the name: anterior cervical discectomy and fusion. Anterior refers to the direction in which the surgeon approaches the patient’s body, and cervical refers to the location where the surgery is conducted.

Anterior Cervical

In other words, the surgeon makes an incision in the front (anterior) neck (cervical). The incision is not only skin deep. Care is taken to safely dissect between various muscle groups and avoid damage to other important structures. The esophagus, trachea, and major arteries and veins are carefully retracted, allowing the surgeon to visualize the targeted spine area..

Discectomy refers to the removal of the herniated disc material. Once the surgeon has reached the bones of the neck and located the targeted disc, the disc material is removed. Without the pressure from the herniated disc, the surrounding tissues — such as the thecal sac, spinal nerves, and spinal cord — are no longer irritated. Any compressing bone spurs are also removed at this stage.

Fusion

Now, fusion, as the name implies, refers to the formation of a single bone from what was originally two vertebrae. The bone edges are scraped clear of soft tissue and contoured appropriately to accept the bone graft or cage that is placed into the empty space that contained the removed disc. The bone or cage then heals together to complete the fusion process. Care is taken to select the appropriately sized graft  or cage  to fit into the disc space.  Usually , a combination of plates and screws  provide stability while the bone grows into the graft. 

Brace

Upon graft completion the surgeon returns all the structures to their proper place and the incision is closed. A cervical collar may be recommended depending on the patient and the intensity of the procedure. As expected, certain activities may be restricted while your body recovers from the operation. Specific questions and individual concerns should be discussed with your surgeon.

Why Get It?

ACDF is the preferred surgical intervention for symptomatic cervical spine  herniations or bone spurs that compress the spinal cord or nerve roots. The most well-studied and well-established causes for ACDF are radiculopathy, and myelopathy.

Those with radiculopathy caused from a pinched nerve are often able to improve with non-surgical treatment. One study shows that most patients showed improvement in their symptoms within 4 to 6 months. As emphasized in my prior videos, ACDF should only be considered when all non-surgical or conservative treatments have been exhausted. 

Concerns

 The presence of spinal cord compression symptoms, or myelopathy,   can be a significant reason for pursuing surgery. Upon the surgeon’s confirmation of the diagnosis by clinical findings, a surgical intervention should be considered. Severe symptoms of myelopathy are more than numbness and radiating pain in a dermatomal distribution.  If there are severe weakness of the legs, or inability to control your bladder and bowels, you must be evaluated immediately. .

Supporting Research

Studies have shown the efficacy of an alternative surgery, cervical disc arthroplasty or disc replacement.  It may  preserve cervical motion and potentially reduces the risk of adjacent segment degeneration compared to ACDF. 

Additionally,  other non-fusion alternatives are available and preferred in some scenarios.  Currently, research is being aimed at improving fusion with 3D printing.  The goal being to improve patient outcomes. 

For a long time, ACDF has and still remains the standard surgical intervention for managing symptomatic disc herniations. Despite boasting a relatively high success rate and low complication rate, it does have room to improve. New technological advancements may result in even better surgical techniques and better patient outcomes.

I hope this video broadened your understanding of ACDF. Until next time, this is Dr. John Shim.

Additional References:

https://thejns.org/spine/view/journals/j-neurosurg-spine/10/4/article-p343.xml

Last modified: February 24, 2021

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