Anterior Cervical Discectomy and Fusion Surgery

Disease Overview

The vertebrae of the spinal column are cushioned by intervertebral discs that act as shock absorbers and allow frictionless movement of your back and neck. They are made up of a soft gel-like center called the nucleus pulposus that is surrounded by a tough outer ring called the annulus fibrosus. A herniated disc is a condition in which the nucleus pulposus bulges out through the damaged or broken annulus fibrosus. This puts pressure on the neural structures, such as nerve roots and/or the spinal cord. Some patients develop arthritis in the small joints of their neck or low back vertebrae, which can cause bone spurs. These bones spurs can also put pressure on the spinal cord or nerves. The pressure on the spinal cord or nerve roots induced by a herniated disc or bone spur may cause pain in the neck and/or arms, numbness or weakness in the arms, forearms or fingers, and lack of hand and leg coordination.

As most nerves to the body (e.g., arms, chest, abdomen, and legs) pass through the neck region from the brain, pressure on the spinal cord in the neck region (cervical spine) can be a serious problem.

What is Anterior Cervical Discectomy and Fusion (ACDF)?

• Anterior cervical discectomy and fusion, also known as ACDF, is the most common operative procedure to relieve compression or pressure on nerve roots and/or the spinal cord due to a herniated disc or bone spur in the neck. The name of the procedure describes exactly what happens during the surgery. The surgeon will enter the patient’s neck from the front (anterior) with an approximately 2-inch incision. The voice box (larynx) and swallowing tube (esophagus) are moved to the side in order to access the bones and discs of the cervical spine.
• The level where the disc and bone spurs are pressing on the nerves is accessed, and the disc and bone spurs are removed. This relieves all pressure off the nerves in order to decrease, or eliminate, the pain passing from the neck down into the arms and hands.
• After relieving the pressure on the nerves, a piece of bone graft material is inserted into the space where the disc was in order to allow the bones to heal (fuse) together. A metal plate and screws are placed into the bones to lock them in and allow them to fully heal together.

What are the Indications for Anterior Cervical Discectomy and Fusion Surgery?

Anterior cervical discectomy and fusion is recommended only after nonoperative treatment fails to alleviate a patient’s symptoms. Nonoperative treatments are very effective at helping relieve a patient’s neck symptoms. These treatments include medications such as anti-inflammatory medications (ibuprofen, or others), nerve medications (gabapentin, or others), cervical physical therapy, and occasionally steroid injections.

Before recommending surgery, your surgeon considers several factors such as your health condition, age, lifestyle and anticipated level of activity following surgery.

How is the Recovery after Anterior Cervical Discectomy and Fusion (ACDF) Surgery?

• After surgery, patients are placed in a cervical collar to give extra support and stability. Usually, patients are discharged the day after surgery and are seen back in the doctor’s office at 3 weeks after surgery to check the incision and x-rays. If all looks good, the patient will be allowed to discontinue the cervical collar.
• Patients are typically maintained on restrictions after the surgery including no lifting with the arms or hands, and no strenuous work for 6 weeks after surgery.
• In some cases, return to work can be as soon as 3 weeks after surgery depending on how their pain is progressing, and what type of work they do.

What are the Potential Risks or Complications of Anterior Cervical Discectomy and Fusion Surgery?

In addition to the anesthetic complications, spinal surgery is associated with some potential risks such as bleeding, infection, damage to adjacent structures (trachea, esophagus, vessels, nerves), nerve damage, blood clots, bowel and bladder problems, failure of fusion of the vertebral bones, spinal fluid leakage, incomplete symptom relief, hardware failure, increased risk of discs above or below the surgery deteriorating faster. Fortunately these risks are rare; the more common risks are sore throat and trouble swallowing. These symptoms resolve after a few weeks.

Why Anterior Cervical Discectomy and Fusion Surgery with Dr. Christopher Kowalski?

Anterior cervical discectomy and fusion (ACDF) is one of the more successful spinal surgeries at relieving a patient’s preoperative symptoms and allowing them to return to normal life. Research shows that most patients who have symptoms of a pinched nerve in their neck will improve with nonoperative treatments as described above, however, if these treatments fail, surgery is a good option to help solve this problem. Dr. Kowalski has extensive experience in performing these procedures and demonstrates excellent patient satisfaction with their outcome.