ACDF (Anterior cervical discectomy and fusion)
What is ACDF?
Anterior cervical discectomy and fusion (ACDF) is a surgery to remove a herniated or degenerative disc in the neck. First, an incision is made in the throat area to reach the front of the spine, then the disc is removed, and a graft is inserted to fuse together the bones above and below the disc.
Who is a good candidate for ACDF?
When non-surgical options (such as over-the-counter medications and prescriptions) don’t work, a cervical disc herniation is likely to respond well to ACDF. Ideal candidates for ACDF include those with:
- Persistent pain for at least 6-8 weeks, without any sign of improvement
- Related arm pain that becomes worse than the neck pain from the herniated disc
- A herniated disc large enough to place ongoing pressure on nearby nerves
- Pain that returns to the same level after various therapies and non-surgical procedures
Preparing for surgery
As you prepare for a fusion, your surgeon will want to know your medical history in order to identify anything that may affect safe conditions for anesthesia and bone healing.
It’s important to pay attention to your nutrition in the weeks leading up to surgery. Diets high in protein, calcium, and vitamin D help in the bone healing process.
Patients should stop smoking or chewing tobacco four weeks before the surgery, and several months after, because nicotine impairs bone healing. Alcohol, caffeine and herbs can cause bleeding problems and should not be taken one week before and two weeks after surgery.
Also, some medications should not be taken prior to or after the procedure, including anti-inflammatory medicines such as aspirin and ibuprofen.
During the anterior cervical discectomy and fusion surgery, you’ll be lying on your back. The surgeon makes a small incision in the front of the neck directly over the disc and creates a pathway to the spine by moving the muscles to the side, somewhat like opening a curtain. This pathway will expose the damaged disc. The surgeon will first remove any bone spurs and disc fragments pressing on the nerves or spinal cord.
If the disc has collapsed from disease, the vertebrae are moved back into their normal position.
To repair the damaged disc, the surgeon then inserts an implant into the space between the vertebrae. Your surgeon may choose to use either an implant made from synthetic material or from actual bone. This implant acts as a support between the two vertebrae to hold them in place while they heal. In order to stimulate fusion and healing of the bone, the surgeon will insert bone graft or other special materials into the disc space.
Finally, the surgeon may need to further strengthen the reconstruction with the addition of a small metal plate and screws. This extra support may aid in bone healing.
The surgeon then completes the surgery by closing the incision area, and may choose to place a small drain at the site for a day or two. Over several months, the vertebral bones and the bone graft material inside the implant will fuse together and become one solid block.
The initial recovery generally lasts about four weeks before you feel completely healed. During this time, your surgeon will take X-rays of your spine, which will help determine when you should return to your daily activities and work.
For the first one to four weeks after surgery, many patients experience some hoarseness, a sore throat, or difficulty swallowing solids. You’ll need to contact your doctor immediately if you develop any swallowing problems that interfere with your ability to breathe or drink liquids.
During the healing process, it’s important to keep an eye on the incision. If it becomes red, tender, if there’s drainage, or if you have a fever over 101 degrees, it’s time to call your doctor.
Sometimes a cervical collar or brace is worn during recovery to limit motion and help with healing. Your doctor may also prescribe physical therapy once your neck has healed.
It typically takes about 3 to 6 months for the bone to heal completely, and your doctor will confirm this with X-rays.
Activities to avoid until healing is complete:
- High-intensity activities (i.e. – running)
- Sexual activity
- Heavy lifting
- Heavy household chores
Getting back to health
Following your ACDF procedure, your challenge in the future is to do what you can to help prevent other discs from getting into the same trouble.
While we can’t stop the aging and degenerating process, certain things can be helpful like maintaining strength in your neck and arms. You’ll want to be careful with extreme lifting, or sports that involve head contact, in order to protect all the healthy discs in your neck. It’s also important to maintain a healthy weight and avoid smoking.
Important Safety Information
Any infection must be promptly treated and every effort must be made to prevent infection. This includes informing all your doctors, even dentists, that you have had an ACDF procedure. Antibiotics must be used before and after medical or dental procedure – a precaution that must be taken for the rest of your life.
The performance of an ACDF procedure depends on your age, weight, activity level and other factors. There are potential risks, and recovery takes time. People with conditions limiting rehabilitation should not have this surgery. Only a surgeon can tell you if an ACDF procedure is right for you.