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Anterior Cervical Discectomy and Fusion: ACDF

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Anterior Cervical Discectomy and Fusion may be performed to treat many conditions. Spinal fusion is a technique used to stabilize the spinal bones or vertebrae. The goal of a cervical fusion is to create a solid bridge of bone between two or more vertebrae. Spinal fusion may be recommended when the natural disc space has decreased or the spine is unstable. 



Anatomy

The spine is composed of individual bones called vertebrae. There are seven cervical vertebrae. They are stacked one on top of another and are separated by discs, which act as an elastic cushions or shock absorbers. The first two vertebrae are an exception and do not have discs. Discs have a soft center, the nucleus, surrounded by a tough outer ring, the annulus. Discs allow motion between the vertebrae. The interbody space is the disc space that is located between the vertebral body bones. Each vertebral segment creates a bony circle, called the spinal canal that protects the spinal cord and spinal nerves.  The spinal cord, which is the nerve center of the body, connects the brain to the rest of the body. The spinal cord and nerves travel from the cervical spine down to the lowest point of your spine, the sacrum. Spinal nerves exit the spinal canal between the vertebrae at each level. Two nerves exit each level, one on the left and one on the right. These nerves exit through openings called foramen. The discs, bony structures, ligaments and strong muscles all work together to stabilize the spine.

Interbody Fusion

Interbody fusion involves placement of fusion cages and bone graft into the area between two vertebral bodies and is an effective method for achieving fusion. The intervertebral cage may be made from a variety of materials including metal, carbon fiber, or bone. Bone graft and bone healing protein may be placed within the cage and within the interbody space to encourage bony healing. The cage helps by separating and holding two vertebrae apart. This increases the opening around the nerve roots at that level, relieving pressure on the nerves. The intervertebral cages can also be used to correct spinal deformity and restore proper alignment. Intervertebral cages can be implanted from the front, side or back of the spine. The location of the surgery is dependent on the specific anatomy of each patient, as well as the location and amount of pressure that may be occurring around the nerves in the spinal canal. In some cases, the surgeon will use additional surgical hardware in the front for stability.

Anterior Cervical Discectomy and Fusion (ACDF)

This procedure is done under general anesthesia, meaning the patient goes to sleep. During the surgery the patient lies face up on a special surgical bed. The procedure is performed through a small incision on the front of the neck, usually in the neck’s natural crease. The trachea (windpipe), esophagus (stomach tube), and blood vessels lie in front of the spine and are carefully moved aside. This can cause some neck swelling after the surgery.

Once the surgeon safely creates a window to see the spine, the damaged disc is partially removed with surgical tools. This is called a Discectomy. Some of the disc wall is intentionally left behind to help contain bone graft material. Once the disc space has been cleared out, the surgeon prepares the bony surfaces for a fusion. The bones are slightly spread apart to make more room for the bone graft. This distracts the bones to realign proper curvature and enlarges the openings to relieve pressure off any pinched nerves.

A cage implant that may be filled with bone graft is placed in the now empty disc space between the two vertebral bodies. The spacer or fusion cage may be made of bone, titanium, or plastic. Bone graft inside the disc space will go on to fuse, healing the two bones together in this area. Benefits of fusion in the anterior interbody space include an increased area for bone to heal, as well as increased forces that are distributed through this area when the patient stands and walks. If the fusion is successful, the vertebrae will only move as one unit. This reduces future problems at this spinal segment. If the bones do not fuse as planned this is called a nonunion, or pseudarthrosis.

Any spine surgery has surgical risks involved. You need to discuss these with your surgeon at your pre-operative appointment.

Read about Preparing for Spine Surgery and General Complications from Spine Surgery.

 

Bone Grafting

There are multiple options for bone graft material for spinal fusion. Surgeons at Virginia Spine Institute may use your own locally harvested bone, called autograft bone. This may come from a combination of bone from the area of the spine being operated on or from your hip bone. Bone grafting can also come from donated and prepared bone, called allograft bone. Read more about how bone grafting is used as a surgical innovation.

Post-Operative Hospital Care

Patients usually remain in the hospital overnight after ACDF surgery. Postoperative pain control will be achieved with the use of IV pain medication and/or oral pain medications. Patients are discharged home on oral pain medication. Patients need to be comfortable with walking. The final goal is to make sure the gastrointestinal and urinary systems are working appropriately. Patients must be able to tolerate foods and urinate without difficulty before leaving the hospital. A neck brace or collar may be worn after surgery. Your surgeon may require you to wear your collar at all times. The brace limits neck motion so that bone can heal properly. It is important to wear your collar as directed.

Read about Recovery from Spine Surgery and make sure you understand your post-operative plan before your surgery date.

Summary

Anterior Cervical Discectomy and Fusion is an approved and effective method for fusing the cervical spine. The goal of surgery is to decrease pain, correct spinal deformity, and improve stability. Complications may occur but are not common. The majority of patients are satisfied with their pain relief and the results of their surgery. It is important that all patients are physically and psychologically prepared. All patients should stop smoking prior to any surgery, as smoking is extremely detrimental to your spine health, potential bone healing and successful surgical outcomes. Please review additional details with your surgeon prior to your surgery.

 

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