Anterior Cervical Discectomy & Fusion

Our necks, clinically known as our cervical spine, consist of seven vertebrae, in-between each vertebra is a spinal disc. If one of those discs is degenerating or has herniated, there is a good chance that the disc may be pressing on the spinal cord or on nerve roots exiting the spinal canal. This is the source of chronic neck pain that can radiate out into your arms and hands.

A procedure known as anterior cervical discectomy and fusion is a way to alleviate pain. This procedure removes the damaged disc and fuses the two cervical vertebrae together, which eliminates the pressure on the spinal cord or nerve roots.

What Is Anterior Cervical Discectomy And Fusion?

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 that is originating in the compressed nerve. These surgeries have two parts. A discectomy is the removal of the disc. Fusion is the fusing of two sequential vertebrae together into a single piece.

We perform ACDF surgery to treat a herniated cervical disc, to alleviate problems caused by degenerative disc disease in the cervical discs, to remove bone spurs caused by osteoarthritis, or to address the narrowing of the spinal canal in a cervical spinal stenosis.

Who Is A Candidate For Anterior Cervical Discectomy And Fusion Surgery?

At Coastal Spine, our first approaches for all cases of chronic pain are conservative treatments such as physical therapy or use of anti-inflammatory medications, possibly even corticosteroid injections into the space surrounding the inflamed nerve roots. In the vast majority of patients, these types of measures can have enough success to make the pain manageable or alleviate it completely

But in about 10 percent of cases, the pressure on the nerve roots or the spinal cord is not reduced, and the pain continues. The only alternative is surgery to remove the herniated or bulging disc.

You would be a candidate for ACDF surgery if you have:

  • MRI or CT scans that show you have a herniated or degenerating disc
  • Significant weakness in your hand or arm
  • Arm pain that is worse than your neck pain
  • Symptoms that are not responding to conservative measures

The problem with continuing compression of the spinal cord or the nerve roots is that it can eventually lead to permanent nerve damage. This can lead to loss of function in the hand, arm, or fingers served by the nerve being compressed.

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What Are The Benefits Of ACDF Surgery?

This surgery is successful in relieving arm pain is from 92 to 100 percent of patients. Neck pain is relieved in from 73 to 83 percent of patients. This procedure tends to be more effective, as those numbers denote, for relieving arm pain. Neck pain will be reduced, but it may not be fully resolved.

However, if you’ve been suffering the chronic pain associated with herniated or bulging cervical discs, it’s likely impacted your life. You’ve likely had to eliminate certain activities and other day-to-day things you do probably involve constant pain. Relieving this pain and returning function is the goal and the benefit of these surgeries at Coastal Spine. By alleviating your neck and arm pain, these procedures also can allow the patient to avoid future use of pain medication.

What Is The Procedure For Anterior Cervical Discectomy And Fusion Surgery?

As mentioned above, there are two components of these surgeries — removing the disc and fusing the two vertebrae. This is the process:

  • Making the incision — You lie on your back and are given general anesthesia. A 2-inch incision is made on the right or left side of your neck. Your surgeon then moves aside muscles in the neck, retracting the trachea, esophagus, and arteries. Finally, the muscles that support the front of the spine are lifted and held aside to gain complete access to the spine and the discs.
  • Remove the disc — We use fluoroscopy to confirm the disc in question and the correct level of the spine. We pass a thin needle into the disc to verify. The vertebrae above and below the damaged disc are then spread apart with a retractor. We cut the outer ring of the disc, the annulus fibrosis, and remove the nucleus pulposus, the soft inner core of the disc. The entire disc is removed.
  • Decompression — We then remove the ligament that runs behind the vertebrae to access the spinal canal. Any disc material pressing on the spinal nerves is removed. Bone spurs that are pressing on a nerve root or on the spinal cord are removed. Usually, the foramen, through which the spinal nerve roots exit the spine, is enlarged. This is called a foraminotomy, and it gives your nerve roots more room to exit the spinal canal.
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  • Fusion — Usually a cage or spacer is then placed between the vertebrae to keep the vertebrae the same space apart as they were with a healthy disc between them. This is accompanied by bone graft material, which may have come from your hip or from donor graft material. In most cases, we attach a small plate to the front of the two vertebrae being fused. This is done with four screws. This provides stability, keeping any movement from occurring between the two fusing vertebrae. Over time, the bone will form in the space where the disc used to be and around the plate and screws. This will unite the two vertebral bones into a single piece.

Is ACDF Surgery Recovery Painful?

One of the real advantages of this approach is that it creates less postoperative pain because the access to the spine is made through a relatively uncomplicated pathway. The anterior access creates less pain than when these procedures are done from the posterior side of the neck.

Most patients after having ACDF surgery complain the most about their sore throat, rather than any pain at the incision site. There can be trouble swallowing large pills or dry foods. You may have pain in the back of the neck and in between your shoulder blades. This can last for weeks but is normal. This is because fusion can create changes in your biomechanics, and this can lead to pain with the attached muscles.

How Long Does ACDF Surgery Take?

Anterior Cervical Discectomy & Fusion takes between 1 and 3 hours, depending on the situation of the patient.

What Should I Expect After ACDF Surgery?

After you’re monitored in postoperative recovery and found to be doing well, most patients are sent home the same day.

This is not a difficult recovery, but there will likely be some issues. These are a couple of potential challenges to recovery from this surgery:

  • Pain away from the incision area — In some patients, the most bothersome pain isn’t at their incision site or in the neck, but elsewhere. Fusion can create pain with the attached muscles and their biomechanics, so you may have pain in the upper back and shoulders. You may have some pain in the hip area if a graft was taken. Your arm pain and tingling usually don’t immediately vanish, and it could actually feel worse for a couple of weeks before it turns the corner.
  • Swallowing difficulties — For the first couple of days after surgery, you’ll need to be on a liquid diet because swallowing will be difficult. From there, you can work in soft foods like yogurt and applesauce.
  • Speaking — When you speak, you’ll have some hoarseness and probably coughing for a few days. Some patients can only speak in whispers for a couple of weeks.

Most patients fully recover after ACDF surgery in4 to 6 weeks. Some patients can return to most everyday activities after just a few days. For the fusion to fully mature, where it heals into one solid strong piece of bone rather than two, it will take a full year to 18 months.

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Is Physical Therapy Required After ACDF Surgery?

Physical therapy is a part of your recovery after ACDF surgery. When we clear you for your PT can vary depending upon how your recovery is progressing, but regular PT will usually start about four weeks after your surgery and continue for 2 to 3 months.

When Can I Return To Normal Activities After ACDF Surgery?

One of the challenges with recovery from ACDF surgery it is impossible to take all the pressure away from your neck after surgery because of the roughly 11 pounds of weight from your head. This makes recovery more difficult than a limb, where you can place it in a cast and basically not use it.

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There can be a temptation to return to normal activities more quickly than you should. You may feel great hitting golf balls before we’ve cleared you to do so, but the pain and fatigue in your neck will typically remind you you’re not ready the next day. By gradually easing back into your normal activities, you can avoid major setbacks. Normal activities aren’t just exercise, either, but everything from housework to grocery shopping to childcare. Again, you can’t keep the weight off your neck.

You will have periods of neck pain as you recover, but here are a few tips to help minimize discomfort and achieve your desired recovery in the optimal six week time frame:

  • Use proper form when lifting — Keep loads close to your body and maintain a neutral neck position.
  • Watch your posture — When sitting, standing, walking, and even sleeping be mindful of the position of your neck.
  • Don’t return to exercise in spurts — Gradually returning to exercise is the only way to go. Don’t try to do more, hitting higher plateaus in rapid steps.
  • Avoid smoking — Smoking has been shown to impede fusion and increase your risk for complications during recovery.

What Are The Risks Involved With ACDF Surgery?

This is a pretty low-risk procedure. Obviously, there are risks involving anesthesia reactions, infection, and poor wound healing, as are present with any surgery. For ACDF surgery, these are potential complications:

  • Long-term pain at the location of the bone graft
  • Difficulty swallowing
  • Difficulty speaking
  • Infection of the incision or any tissue affected by the surgery
  • Infection of the vertebrae
  • Excessive bleeding
  • Pain is not fully relieved
  • Failure of the bone graft to solidly fuse
  • Nerve root damage
  • Damage to the trachea/esophagus
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Will I Have Restrictions After Surgery, Such As Wearing A Neck Brace?

You won’t be able to drive for probably 2 to 4 weeks, depending on your situation. You’ll need to avoid sitting for long periods of time. You won’t be able to lift anything heavier than about 5 pounds. You’ll need to avoid bending your head forward or backward.

Improvements in technology in the brackets and screws used to support the fusing vertebrae have lessened the need for patients to have to wear cervical collars, so this is no longer a guaranteed requirement. In rarer cases, a patient will have a necessity for a longer immobilization period, and he or she could be required to wear a hard collar for 4-12 weeks. This is rare.

We’ll discuss your particular situation before your surgery and, of course, afterward.

What Kind Of Scarring Will I Have From ACDF Surgery?

The incision for this procedure is placed in the natural crease of your neck skin. Initially the scar will be red or maroon, and it will remain so for several months. But by the time of 6 to 12 months the scar is starting to disappear. After one year, it may be so nondescript that you’ll have a hard time remembering which side of your neck the incision was made.

Scarring is not a problem with these procedures, thanks to our natural creases in the neck skin. Of course, if you are prone to forming keloid scars or have other complications with your wound, that could be a problem, but these types of issues are very rare.

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