IntroductionAnterior Cervical Discectomy and Fusion (ACDF) is performed to remove pressure off of one or more nerve roots and/or the spinal cord.
This procedure commonly is used to treat cervical disc herniations, cervical spinal stenosis, cervical degenerative disc disease, cervical myelopathy, and cervical spondylosis.
Anterior Cervical Discectomy and Fusion surgery has a very high success rate in alleviating radiating pain in the arm(s) and scores high in satisfaction for the appropriately selected patient. In fact, under the most ideal of circumstances which is a single level disc herniation, in a healthy, active individual, success rates approach 95%. This procedure can be performed on an outpatient basis for many patients. While new types of instrumentation and implants continue to be developed, the overall ACDF technique continues to be the gold standard approach for many degenerative conditions of the cervical spine.
As with any surgical procedure, there are potential risks and benefits that should be discussed and considered.
Description of ProcedureThis surgery is performed under general anesthesia. Once you are comfortable and asleep, you will be positioned on your back. Live x-ray is used to localize the area of your incision.
A small incision will be made along the anterior (front) side of your neck going slightly to the left side. A plane is entered between layers of muscle that allows for access down to the level of bone (front of the neck). Once the correct disc is identified, a discectomy is performed to remove a majority of the disc from the front of the neck. The decompression can then be performed which allows the surgeon to remove any pressure off of the nerve roots and/or spinal cord from disc material or bone spurs.
Once decompressed, a piece of bone (allograft) will be cut and placed in each disc space where the disc has been removed. The bone will be tailored to fit this space and re-create the original height of the disc that occupied this space. This is performed to stabilize the spine and eventually create a fusion. A small titanium plate will then be placed over the front of the neck bones and secured with small screws to create a rigid environment and limit motion so that the bones can fuse together.
The advantage of this approach is that it allows the surgeon direct access to the level of the disc and bone while only having to split a minimal amount of muscle. This helps limit post-operative pain.
For a one or two level procedure, this is expected to be an outpatient procedure. If you are having three or more levels operated on, this would be performed at the hospital in which you would stay for at least 1 night. If your pain level is tolerable and you are doing well medically, you can expect to be discharged.
For a one or two level procedure, you will leave the hospital or surgery center with a soft cervical collar. You may take this off when you wish. We encourage you to wear it for the first week, especially when outside the home. For larger surgeries involving 3 or more levels, you likely will be placed into a more rigid cervical collar. Dr. Shim will discuss with you how long you will have to wear this collar after surgery.
No, it is against the law to drive a motor vehicle with a cervical collar on. You will need to wait until the collar is removed before you may drive.
While everyone’s pain tolerances and conditions differ, most recover from this type of surgery within a 4 to 6 week time period.
This depends on the type of work you perform and the duties involved. In general, most patients can return to a sit down type job with no lifting required within approximately 2 weeks after surgery. Those patients who have heavier duty occupations requiring lifting, pushing, pulling, and overhead activity can expect to be out 4-6 weeks.
For a one or two level procedure, most patients can safely return to driving within 10-14 days after surgery. Those who have 3 or more levels operated on and are placed in a rigid collar, may not drive for up to 6 –8 weeks. Please keep in mind that if you are taking narcotic pain medication and/or wearing a cervical collar, you should not drive a motor vehicle.
Your incision is closed with dissolving sutures under the skin. The skin is held together with steri-strips until the wound is healed. A Silverlon dressing will be placed over the surgical incision. This should be left on until your first post-operative visit with Dr. Shim. If it begins to fall off, please contact the office.
As a normal part of the post-operative period, we encourage you to get up and walk shortly after your surgery. You may walk as much as you can tolerate.
At the time of your first post-operative visit in the office with Dr. Shim, you will be instructed to begin gentle range of motion exercises for your neck. Most patients are able to do their own therapy at home and do not require a formal therapy program.
You incision was closed with dissolving sutures. Therefore, there is nothing that has to be removed.
Yes, you may resume sexual activities as soon as you feel up to it. This may be a few days or even a week after you come home from the hospital. You should avoid positions which cause increased neck discomfort.
Most patients are free to travel after their initial post-operative visit 12-14 days after surgery. Patients who may have been experiencing any problems during this time may be encouraged to wait a little longer before traveling. Keep in mind, you will not be able to carry any heavy luggage greater than approximately 10 –15 pounds for the first 4 weeks after surgery. For international patients who are considering this surgery, please see our program schedule for returning home.
You may take a bath upon your return home, but you should avoid getting your neck and head wet. Most patients can safely resume a normal bath 3 weeks after surgery.
One of the benefits of the Silverlon dressing is that you may get it wet. You may begin showering the second day after surgery. We encourage you to turn your backside to the shower head to avoid the water saturating your dressing.
Yes, in approximately 3 weeks after surgery. The incision needs to be completely healed before you swim.
Everyone’s pain tolerances and conditions do vary. In general, many patients experience some relief of their arm symptoms immediately after surgery. It is not uncommon to have neck soreness, stiffness, and incisional discomfort for several weeks beyond surgery. For some patients, the pain level may decline slowly over weeks or even months after surgery.
Several reasons for this. First, you were given medications to help relax you and your pain during the surgery along with the anesthesia. This combination of medications may stay in your system for a day or two after surgery. Secondly, as you start feeling better, most patients become a bit more active, this can lead to increased discomfort initially.
A sore throat can result from anesthesia in some cases. You received an endo-tracheal intubation (“tube”) into your throat to help you breath during the procedure. This may have irritated the lining of your throat. Also, for patients who undergo surgery on the lower aspect of your neck, you can develop irritation from a nearby nerve. This soreness and even some difficulty swallowing tends to resolve within a few weeks after surgery.
In general, a healthy, non-smoking adult with no significant other medical problems can expect to see evidence of fusion in 4 to 6 months after surgery. Patients who do smoke or are diabetic tend to take longer to fuse. In some cases, it may take a year to fuse.
If you experience any fevers over 101.5 degrees, any wound drainage, swelling or redness around your surgical incision, increasing pain, tingling or numbness that you did not have before surgery, difficulty swallowing, difficulty walking, severe headaches or weakness, call your doctor.
You can lift up to 5 lbs. after surgery until your first post-operative visit. After 12 – 14 days, Dr. Shim will allow you to gradually increase your ability to lift.
RisksSome of the risks and complications associated with this procedure include:
- Wound infection
- Damage to carotid artery resulting in excessive bleeding or stroke
- Nerve injury including paralysis
- Loss of bowel or bladder function
- Difficulty swallowing
- Hoarseness (temporary or permanent)
- Hardware failure including loosening of screws
- Pseudoarthrosis (failure to fuse)
- Blood clots
- Development of degeneration at segment above or below fusion
- Numbness (temporary or permanent)
- Incomplete relief of symptoms
- Risks associated with anesthesia
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