Anterior Cervical Discectomy with Instrumentation & Fusion (ACDF)
For patients who have cervical stenosis or cervical disc disease, an anterior cervical discectomy and fusion may be recommended. The procedure provides relief for people with neck, arm, and hand pain caused by arthritic bone spurs or herniated disc(s) pressing on one or more nerves. This procedure also provides relief for people suffering loss of function because of compression of the spinal cord from either bone spurs or herniated disc(s).
During the procedure, an incision is made in the side of the neck, often in a skin crease to minimize the visibility of a scar. Metal retractors are used to protect the trachea, esophagus, carotid artery and jugular vein, and the use of retractors may cause a sore throat for a short period following surgery.
The surgeon will use an operating microscope for better vision when removing the disc, bone spurs and protrusions, as well as enlarging the opening for the nerve roots. Typically, a synthetic interbody strut (mechanical characteristics essentially the same as bone) is used to replace the disc. This strut is packed with some of the patient’s own bone shavings as well as donor bone which has been sterilized and specially prepared to aid in the healing process. In the past, the patient’s own hipbone was used to replace the disc. While this was extremely successful, for far too many patients the resultant hip pain outweighed the benefits. Overall, the use of synthetic strut, local bone and the donor bone (as described) yields similar results, without the risk of pain at the hipbone. Occasionally, due to certain medical reasons, the patient is better served by the use of his/her own hipbone. The replacement bone is inserted between two vertebrae, and a secure fusion forms over the next few weeks to months, and continues to mature. This fusion will eventually provide lifelong natural support. A titanium plate and screws may be added to serve as a stabilizer until the fusion is complete.
Post-surgery, the surgeon may require the patient to wear a neck collar for several weeks. Depending on the extent of the surgery, patients are able to return to normal activities. As a rough estimate, expect four weeks for one level, 6-8 weeks for two levels, and 8-12 weeks for 3-4 levels. It is very important to remember that everyone heals at their own pace. As a result, we customize our care to fit each patient’s individual needs.
For most patients, the typical post-surgical hospital stay is 24-48 hours, however patients undergoing a one level discectomy may go home the same day. Any mild discomfort at the surgical site can be addressed through oral pain medications and the minor sore throat that often accompanies the procedure clears up quickly. Symptoms may improve immediately or gradually, dependent upon the patient’s preoperative condition, compliance with health care provider recommendations and realistic expectations following the surgery. Patients who smoke cigarettes should cease immediately because smoking significantly interferes with the bone’s ability to heal. Patients are encouraged to walk immediately after surgery, but bending, lifting and twisting are to be avoided for at least four to eight weeks.
Anterior Cervical Discectomy and Fusion