ANTERIOR CERVICAL DISCECTOMY AND FUSION (ACDF)
An anterior cervical discectomy and fusion is a surgical procedure to treat nerve root or spinal cord compression by decompressing the spinal cord and nerve roots of the cervical spine to stabilize the adjacent vertebrae. Conditions which can be treated by this surgical intervention are cervical herniated disc, spondylosis, degenerative disc disease. The surgeon takes a front (anterior) approach, either right or left, to access the spine. The intervertebral disc is removed to free the nerve or spinal cord from compression and replaced with a cadaver bone graft. The goal is for the bone graft to “fuse” with the joining vertebrae. This process of the fusion is a very slow process, therefore to instill stability, a titanium plate and screws are used to make the cervical spine stable and secure.
Patients are positioned in the supine (lying on the back) position, generally using a standard flat operating table. The surgical region (neck area) is cleansed with a special cleaning solution. Sterile drapes are placed, and the surgical team wears sterile surgical attire such as gowns and gloves to maintain a bacteria-free environment.
A 2-4 centimeter (depending on the number of levels) transverse incision is made in one of the creases of neck, just off the midline. The cervical fascia is gently divided in a natural plane, between the esophagus and carotid sheath (area containing the blood vessels in the neck). Small retractors and an operating microscope are used to allow the surgeon to visualize the anterior (front part) vertebral body and discs. After the retractor is in place, an x-ray is used to confirm that the appropriate spinal level(s) is identified.
A complete discectomy (removal of the disc, including the protruding fragment) is typically performed, allowing the spinal cord and nerves to return to their normal size and shape when the compressive lesions are removed. Small dental-type instruments and biting/grasping instruments (such as a pituitary rongeur and kerrison rongeur) are used to remove the herniated disc. All surrounding areas are also checked to ensure no compressive spurs or disc fragments are remaining. The size of the empty disc space is measured; a graft size is chosen so as to restore the normal disc space height and the graft is then gently tapped into the disc space, in between the two vertebral bodies. A small titanium metal plate is frequently placed, affixed to the vertebrae with small screws, to impart immediate stability to the construct and allow for optimal bone healing and fusion. X-rays are then used to confirm appropriate position and alignment of the graft and hardware.
The wound area is usually washed out with sterile water containing antibiotics. The deep fascial layer and subcutaneous layers are closed with a few strong sutures. The skin can usually be closed using special surgical glue, leaving a minimal scar and requiring no bandage.
The total surgery time is approximately 2 to 3 hours, depending on the number of spinal levels involved.
This surgery requires a short stay in the hospital, anywhere from 1 -3 days with a recovery period of 1 -2 weeks with restrictions and limitations. Patients are instructed to avoid bending and twisting of the neck in the early postoperative period (first 2-4 weeks). Patients can gradually begin to bend and twist their neck after 2-4 weeks as the pain subsides and the neck and back muscles get stronger. Patients are also instructed to avoid heavy lifting in the early postoperative period (first 2-4 weeks). Some patients are placed in a soft cervical collar for comfort to help decrease pain and to improve bone healing.
Patients can shower immediately after surgery, but should keep the incision area covered with a bandage and tape, and try to avoid the water from water hitting directly over the surgical area. After the shower, patients should remove the bandage, and dry off the surgical area. . Patients should not take a bath until the wound has completely healed, which is usually around 2 weeks after surgery.
Return to Work/Sports:
Patients may return to light work duties as early as 2-3 weeks after surgery, depending on when the surgical pain has subsided. Patients may return to heavy work and sports as early as 8-12 weeks after surgery, when the surgical pain has subsided and the neck and back strength has returned appropriately with physical therapy.