Anterior Cervical Discectomy and Fusion (ACDF)

Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure in the cervical spine (neck).

This minimally invasive procedure takes an anterior (from the front) approach to decompress the spinal cord and nerve roots, remove damaged disc(s) and fuse the bones together.

With this approach, one, two, or multiple discs can be decompressed and fused. Sometimes, in certain situations, the entire vertebral body can be removed, called a corpectomy.

EvergreenHealth surgeons also provide cutting edge disc replacements, an alternative to fusion through this same approach, usually for one or two levels in carefully selected patients.

ACDF is typically used to treat: cervical disc herniation, cervical stenosis, myelopathy, radiculopathy, spinal instability, cord compression, infections of the spine, cancer of the spine

Having Anterior Cervical Discectomy and Fusion (ACDF) Surgery

During an ACDF, you will lie on your back and the surgeon will make a small incision on the left or right side of your neck, just off the midline.

The surgeon will then retract your esophagus, trachea, blood vessels, ligaments and muscles off to either side. This approach to surgery provides a straightforward pathway to your spine and minimal soft tissue damage.

Using X-ray fluoroscopy and a microscope, your surgeon will identify the disc or level causing your symptoms.

The surgeon carefully removes the disc, bone spurs, herniated fragments, cartilage and calcified disc fragments. This allows us to directly decompress your spinal cord and nerve roots.

Once completed, a special-sized cage fitting your exact anatomy is placed into the empty space.

This structural cage helps restore normal disc height and provides stability during spinal fusion.

Oftentimes, a plate and screw is placed over the cage to provide additional structural support and aid the fusion process.

How Anterior Cervical Discectomy and Fusion (ACDF) Surgery Works

The ACDF is one of the most successful surgeries that spine surgeons perform in terms of patient satisfaction and outcome, and is often a surgeon’s preferred surgery for a variety of reasons.

First, the source of compression can be directly removed, whether it stems from herniated discs, bulging discs, or bone spurs from arthritis.

Second, the surgeon has access to the nerve roots as well, ensuring those are free from compression as well.

Placement of a cage allows us to "rebuild" your neck at its proper height and reestablish a more normal curve that we often lose as a result of aging and arthritis.

This approach allows for minimal muscle damage; usually we can get to your spine between the various tissue planes of the neck including the muscles and ligaments of the anterior neck.

This usually results in less pain after surgery and faster recoveries.

Benefits of ACDF

ACDF procedures generally require less muscle disruption than other approaches to the cervical spine, usually resulting in less post-operative pain.

Depending on a patient’s specific problem, it allows us to directly decompress the spinal cord, and directly remove the offending agent.

ACDF also affords your surgeon greater ability to restore lordosis (the normal curve in your neck), and rebuild disc height that is often lost with aging and arthritis.

Recovery tends to be fast with shorter hospital stays as well.

After Anterior Cervical Discectomy and Fusion (ACDF) Surgery

The vast majority of patients who have the ACDF procedure leave the hospital within 24 hours after surgery.

Patients are typically kept overnight as a precautionary measure to monitor the ability to breathe, speak and swallow.

The ACDF procedure can be performed safely in an outpatient environment under careful and controlled circumstances.

Recovery and prognosis after ACDF are excellent. Recovery from the initial surgical procedure can take a few days to a week.

Flexibility and range of motion may reduce as a result of the fusion.

Muscle spasms between the shoulder blades are also common in the weeks after surgery.

Typically, most patients are able to return to basic functioning (cooking, cleaning, walking up and down stairs, etc.) within a few days.

Dysphagia, or difficulty swallowing, can take a few weeks to improve, but most patients have no problem adjusting their diet for a week to softer foods in the meantime.

Generally, patients wear a cervical collar for a month after surgery, start physical therapy by month 2, and return to their normal activity by 6 months.

Activities to avoid in the first month include excessive bending, twisting, or heavy lifting greater than 10 lbs.

The majority of patients can return to normal activity within six months without restriction.

If you undergo multi-level ACDF, or if ACDF is part of a large staged reconstructive procedure, your recovery will take longer.