Anterior Cervical Discectomy and Fusion
Neck pain can be caused by aging, injuries or other medical conditions, such as compression in the spinal cord or nerves in the cervical spine (bones in the neck). Anterior cervical discectomy and fusion (ACDF) may be recommended if conservative treatment options are not enough to remove pain, which may affect the neck and the arm.
At Nacogdoches Medical Partners, we’re here to help you learn more about your health condition and whether ACDF may suit you. We have a dedicated neurological critical-care unit, long-term rehabilitation and outpatient follow-up care to help provide compassionate care for communities in Nacogdoches, TX.
Cervical Spine Anatomy
To better understand how ACDF works, it helps to learn a bit about the human spine anatomy. The spine (backbone) is made of many bones called vertebrae. At the vertebrae’s center is a canal where the spinal cord runs through. Nerve roots branch off the spinal cord and pass through the small spaces between the vertebrate to travel into various body areas.
Like the rest of the backbone, the cervical spine contains intervertebral discs. These are round and flat cushioning that act as shock absorbers and allow you to rotate and flex your head during movement. The cervical spine is more flexible but less protected than other parts of the spine. It is vulnerable to injuries and disorders that cause neck pain and stiffness.
ACDF may be recommended for patients with the following conditions:
- Cervical degenerative disc disease – characterized by the drying out of the disc’s nucleus pulposus, the gel-like structure that helps absorb shock. This dehydration may reduce the height of the disc, resulting in pain and abnormal motion due to the compression between the vertebrae. Cervical degenerative disc disease can further minimize movement in the cervical spine and pinch the nerves.
- Disc herniation – as the disc ages, it can dry out, crack and bulge, placing pressure on the nerve root or spinal cord.
- Cervical stenosis – the abnormal narrowing of the cervical spinal canal, compressing the spinal cord or its nerve roots. This condition can affect movement, touch sensation or bowel or bladder control.
What Is ACDF Surgery?
ACDF surgery aims to relieve spinal cord or nerve root pressure through discectomy, which removes all or part of a damaged cervical disc. The procedure is performed under general anesthesia, which puts you in a deep sleep. The surgeon accesses the damaged disc from the front (anterior) of the cervical spine through the throat area.
Depending on the extent of the damage, one disc (single level) or more (multilevel) may have to be removed. ACDF is often performed along with fusion, wherein a bone graft material is inserted in the place of the removed damaged disc to prevent the vertebrae from collapsing or rubbing together.
The graft then serves as a bridge between the vertebrae as new bone cells grow naturally around it and fuse the bones. Metal plates and screws are used to secure the bone graft and vertebrae. After three to six months, the bone graft should fuse the two vertebrae into a piece of solid bone.
Some patients may notice a reduced range of motion after fusion, but this may vary according to the patient’s pre-surgery neck mobility and the number of bones fused. One-level fusions may result in a similar or better range of motion than before ACDF. If multilevel fusions are performed, it may result in limited head movement when turning or looking up and down.
What Is the Success Rate of Anterior Cervical Discectomy and Fusion?
A study by the University of Calgary Spine Program published on the Lippincott Medicine website found that up to 83% of patients who underwent ACDF for neck pain reported positive results, while 93% to 100% of ACDF patients reported relief from arm pain. Patient preparation and education may help increase the success rate of ACDF. At Nacogdoches Medical Partners, we will help you understand ACDF and answer any questions you may have.
Our doctors will examine your complete medical history. You will also undergo a physical examination to ensure you’re in optimal health before the procedure. Let your doctor know if you’re allergic to medications, latex, tape or anesthesia. Disclose all the supplements and medications you’re taking and if you have a history of bleeding disorders. You must stop taking medications that affect blood clotting before the procedure. Tell your doctor if you’re pregnant or think you could be.
Follow your doctor’s instructions not to drink or eat before your scheduled ACDF. The general anesthesia from the procedure will make you unable to do certain activities after surgery, so arrange for someone to drive you home and help with the household chores for a few days.
What Is the Difference Between a Cervical Discectomy and a Fusion?
Discectomy and fusion are two surgical processes involved in ACDF. Cervical discectomy relieves pressure in the nerve root or spinal cord by removing a part of or the entire damaged cervical disc. Fusion is done by replacing the removed disc with a bone graft to promote fusion between the vertebrae where the damaged disc used to be.
What Happens After ACDF?
You will be brought to the recovery area, where your vital signs will be monitored. Most patients who undergo one- or two-level ACDF procedures will be sent home the same day. However, you may need to stay in the hospital overnight if you have unstable blood pressure or difficulty breathing. Your surgeon will give you home care instructions for two weeks after surgery or until your next follow-up appointment. Instructions may include:
- Activity limitations
- Surgical incision site care
- Medications
- Wearing a neck brace, if needed
- When to call your doctor
How Long Is Recovery From Anterior Cervical Discectomy and Fusion?
How soon you can return to your usual activities will depend on your overall health before or after ACDF, the number of fusions made, possible complications that may arise post-surgery and many more. In some cases of single-level ACDF, patients may be able to go home the same day. In other cases, patients will have to stay overnight in the hospital. Here’s an estimated time frame of activities recommended by surgeons from a study that patients may be able to do following surgery:
| Activity | One-Level ACDF | Two-Level ACDF | Three or More Level ACDF |
|---|---|---|---|
| Driving off pain medications | Two weeks | Two weeks | Two weeks |
| Light duty or clerical work | Two weeks | Two weeks | Two weeks |
| Medium duty such as a nurse, truck or forklift driver | Four to six weeks | Six weeks | Six weeks |
| Heavy labor, such as construction and bricklaying | Eight weeks | Eight to 12 weeks | Three months |
| Low-impact exercise: a stationary bike or elliptical | Four weeks | Four weeks | Six weeks |
| Non-contact sports: tennis, softball or weightlifting | Eight weeks | Eight weeks | Three months |
| High-risk activities or contact sports: football or roller coaster | Three months | Six months | 12 months |
The recommendations above may only suit some ACDF patients. Always talk to your doctor if you plan to do certain activities following your surgery. Your doctor can help create customized time frames for your return to work and various activities that are safe for you.
Tell your doctor right away if you experience any of the following signs of infection following ACDF:
- High fever
- Discharge or bleeding from the surgery incision
- Abnormal redness or swelling of the incision site
- Pain that doesn’t relieve with medication
- Trouble swallowing
- Stiffness or intense pain in the neck
