Anterior cervical discectomy and fusion (ACDF) is a type of neck surgery that involves removing a damaged disc to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness, and tingling. A discectomy is a form of surgical decompression, so the procedure may also be called an anterior cervical decompression.
The surgery has 2 parts:
- Anterior cervical discectomy. The surgery is approached through the anterior, or front, of the cervical spine (neck). The disc is then removed from between two vertebral bones.
- Fusion. A fusion surgery is done at the same time as the discectomy operation in order to stabilize the cervical segment. A fusion involves placing bone graft and/or implants where the disc originally was in order to provide stability and strength to the area.
While this surgery is most commonly done to treat a symptomatic cervical herniated disc, it may also be done for cervical degenerative disc disease. It is also commonly done to remove bone spurs (osteophytes) caused by arthritis and to alleviate the symptoms associated with cervical spinal stenosis.
An ACDF is done with an anterior approach, which means that the surgery is done through the front of the neck as opposed to through the back of the neck. This approach has several typical advantages:
- Direct access to the disc. The anterior approach allows direct visualization of the cervical discs, which are usually involved in causing the stenosis, spinal cord or nerve compression, and symptoms. Removal of the discs results in direct nerve and spinal cord decompression. The anterior approach can provide access to almost the entire cervical spine, from the C2 segment at the top of the neck down to the cervicothoracic junction, called the C7-T1 level, which is where the cervical spine joins with the upper spine (thoracic spine).
- Less postoperative pain. Spine surgeons often prefer this approach because it provides access to the spine through a relatively uncomplicated pathway. The patient tends to have less incisional pain from this approach than from a posterior operation.
After a skin incision is made in the front of the neck, only one thin vestigial muscle needs to be cut, after which anatomic planes can be followed right down to the spine. The limited amount of muscle division or dissection helps to limit postoperative pain following the spine surgery.
Surgical description
Before surgery, intravenous antibiotics are given to reduce the risk of infection. The surgery is performed through a small incision on either the right or left side of the neck over the herniated disc. Surgical dissection continues down to the cervical spine while gently retracting the large artery in the neck (the carotid artery) to one side, while the swallowing tube (esophagus) and breathing tube (trachea) are pushed to the other side. The level of the patient’s herniated disc is confirmed with X-rays. The microscope is then used for the remainder of the operation. After the herniated disc is removed, the neurosurgeon can see and remove any bone spurs pressing on the nerve or spinal cord. The area is then inspected to ensure there are no disc fragments or other structures that may be compressing the nerve or spinal cord. The wound is irrigated with an antibiotic solution to reduce the likelihood of infection. A fixed or mobile artificial disc made of titanium, or natural or artificial bone, is then placed at the site of the removed disc. Often, a titanium plate is placed in front of the spine using screws in the cervical vertebrae above and below the discectomy to maintain spinal alignment. You may need to wear a cervical collar after surgery. If necessary, it will be placed on your neck at the end of the operation.