Anterior Cervical Discectomy and Fusion (ACDF)
Anterior Cervical Discectomy & Fusion (ACDF) removes a herniated or diseased disc and relieves neck and radiating arm pain caused by parts of the disc pressing on nerve roots.
What is an ACDF?
Anterior cervical discectomy and fusion (ACDF) is a minimally invasive surgical procedure that relieves symptoms caused by a bulging or degenerative disc in the neck. Pressure on a cervical nerve root may cause numbness, muscle weakness, and pain focused in the hand and arm. Anterior cervical discectomy and fusion is an outpatient operation with a 92-100% rate of success in alleviating symptoms. The brief post surgery recovery time of 4-6 weeks and low complication risk make anterior cervical discectomy and fusion an attractive option for patients who do not find relief through physical therapy and appropriate exercise.
Anterior cervical discectomy and fusion (ACDF) is an outpatient procedure that effectively treats pain and numbness in the neck, arm, and hand. A large percentage of patients with symptoms resulting from a herniated or degenerative disc in the neck find relief from non-surgical options, including tailored physical therapy and weight management. If non-surgical options do not provide relief, consult with a DISC physician about minimally invasive techniques. The need for multilevel fusions should be exceedingly rare. Importantly, numbness and weakness in the arm should be given a high priority as permanent nerve damage may occur if left unevaluated over long periods of time.
At DISC, the decision to perform a fusion is always arrived at within a conservative framework and with an appropriate recovery and rehabilitation plan in place. While hospital based open fusions typically require large incisions and lengthy hospital stays, the minimally invasive technique performed entirely though a specially designed operating microscope is undergone on an outpatient basis. Patients enjoy the peace of mind of a substantially reduced risk of infection (DISC maintains a zero MRSA infection rating while hospitals range from 5-10% annually), significantly less tissue damage and displacement leading to a more rapid and full recovery. Also, the privacy and personalized comfort of the DISC surgical center provides patients with a a sense of confidence and relaxation atypical of the hospital experience.
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ACDF Symptoms and Anatomy
A cervical disc, or an intervertebral disc in the neck, absorbs impact and trauma – stabilizing the head and providing a comfortable platform for vertebrae to rest upon. A vertebral disc is composed of a tough collagen exterior, called the annulus, and a jelly-like interior. Tears to the annulus can cause the interior of the disc to protrude, or herniate, into the area normally occupied by the nerve root and spinal cord. Normal wear and tear of a cervical disc can cause vertebrae to improperly align and rub together, promoting formation of reactive bone spurs. This may develop into foraminal cervical stenosis, or the narrowing of nerve root channels in the neck. Encroachment on the nerve root by either mechanism may cause numbness, muscle weakness, and pain focused in the hand and arm.
Anterior cervical discectomy and fusion relieves pressure on a nerve root in the neck by removing inappropriate tissue and bone. An anterior approach, or operating from the front side of the neck, avoids disruption of the spinal cord, spinal nerves, and disturbing the large muscle tissues in the back of the neck. This creates a safer, less invasive procedure with shorter recovery time.
Anterior Cervical Discectomy and Fusion Procedure
A small incision is made on the anterior surface, or front, of the neck. Utilizing fluoroscopy (real time X-ray) the surgeon can confidently locate the symptomatic area. Ruptured and problematic disc tissue is removed, relieving pressure on the nerve root and spinal cord and preparing the space for fusion. In more extreme cases, bone spurs are removed and nerve exit windows are enlarged (foraminotomy).
The space between the vertebrae that was previously occupied by the intervertebral disc is prepared to promote a healthy fusion with the bone graft, ensuring neck stability and decreasing the chance of further issues. A bone graft can be obtained from the patient’s hip (autograft), from a donor (allograft), or a synthetic substitute may be used. A metal plate can be used to ensure proper fusion alignment. Generally, the vertebrae fully fuse 3-6 months after surgery.
ACDF Relief and Concerns
Hoarseness and discomfort swallowing for a short time after surgery may be experienced. This does not typically persist for more than a few weeks. Prior symptoms of numbness in the arm and hand may similarly take up to a month to fully recover.
Fusion of a single level of vertebrae often results in increased mobility of the head. Fusing two or more levels may being to impinge upon movement. Using the “finger rule” or placing an equivalent number of fingers to fused levels perpendicular to the neck and bending the head forward can roughly estimate impairment.
Physical therapy, good posture, and weight and lifestyle management are all-important contributors for a full recovery. Statistically patients may develop disc degeneration at the levels above and below the fusion, over long periods of time. For this reason it is exceeding important for patients to maintain a diligent physical therapy plan during and after recovery in order to maintain active, natural function of the spine. A proper diagnosis and well-designed treatment plan help patients navigate the path to the need for fusion. DISC’s highly trained specialists work together in a multidisciplinary setting, ensuring patients receive the correct diagnosis, and that an appropriate treatment plan is laid out accordingly. From in house next-generation imagining though pain management, to minimally invasive surgical intervention and on to recovery and rehabilitation at the Soft Tissue Center, DISC patients receive the attention and information they need to make the right decisions for their long term health and well-being. Learn more about DISC’s Spine Care specialists.
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For more information about ACDF visit American Academy of Orthopedic Surgeons-AAOS