Anterior Cervical Discectomy and Fusion: What Is It?
Anterior cervical discectomy and fusion, better known as ACDF, is a surgical procedure to help alleviate neck and arm pain form a herniated disc in the vertebrae. The procedure is performed on various groups of people with different backgrounds, and from all walks of life due to the varying risk factors of a herniated disc. Such risk factors include:
- Age: Herniated discs tend to occur in middle aged individuals, typically between 35 and 45 years of age. This risk factor has been attributed to degeneration of discs in the vertebrae over the years.
- Weight: Those suffering from obesity and excess weight are at a higher risk of suffering from a herniated disc due to the extra stress on the lower back.
- Occupation: Individuals engaged in jobs requiring a great demand of physical labor typically suffer from back problems. Athletes are also at risk for herniated discs due to the demands of their jobs, including repetitive motions, heavy lifting, pushing and pulling.
Who Needs ACDF?
A herniated disc in the spine can cause excess pressure on a nerve root, or on the spinal cord itself. This creates issues of pain, tingling or numbness in an individual's neck, arms and even around his or her legs. Pressure can increase through the creation of bone spurs, which is buildup that forms around the edges of the affected area of the herniated disc. ACDF is performed to alleviate this excess pressure by removing the disc and fusing the vertebrae above and below the disc together for stability.
Understanding the ACDF Procedure
The surgery is titled "Anterior" due to the fact that it is performed at the front portion of the neck around the individual's throat. An ACDF is actually two procedures combined into one.
Cervical discectomy consists of surgically removing the herniated disc. The surgeon would reach the herniated disc through the individual's throat region, moving past the neck muscles, trachea and esophagus. Disc removal can be categorized as single-level for the removal of a single disc, or multi-level for the removal of multiple discs.
While it would seem more efficient to reach the vertebrae through an individual's back (posterior), it is actually quite the opposite. An anterior approach through the front allows the surgeon to reach the vertebrae while avoiding the spinal cord, spinal nerves and the tough neck muscles of the back. This method of surgical entry is less complicated and is less painful for the patient.
Cervical Spinal Fusion
Cervical spinal fusion fills the gap in the vertebrae once the herniated disc is removed. This part of the procedure prevents the vertebrae from completely collapsing or rubbing together. A bone graft is used to bridge the gap between two vertebrae after a herniated disc is removed. Similar to certain knee surgeries, a bone graft is taken from another portion of the body, or from a bone bank where it can be obtained from a donor. A bone graft can also be artificially made from material like plastic or ceramic. In some cases, a surgeon may include the addition of metal plates attached to the vertebrae for added stability and to help the healing process.
Patients who undergo ACDF are typically allowed to return home on the same day, or after a one night stay in the hospital. Recovery time may vary, but it is commonly stressed that patients approach the procedure and rehabilitation with a positive attitude. Pain and numbness are common once the surgery has completed, and will lessen as time passes. A cervical collar may be issued by the patient's physician.
The physician will determine when it is appropriate for the patient to return to work. Walking on a daily basis is the recommended form of exercise during the recovery process. It is recommended that the patient gradually wean off of any pain medication prescribed for a faster recovery.
While ACDF is a common procedure, it does come with its risk of complications:
- The procedure may not alleviate the arm or neck pain it was intended to.
- There is a chance that spinal fusion may not occur.
- The patient may suffer a swallowing or speech impediment.
- Damage to the trachea or esophagus may occur.
- There is a slight chance that the spinal cord may be damaged during the procedure.
Like all forms of surgery, ACDF cannot be guaranteed to be without any form of complications. Patients should discuss the potential risks involved in ACDF with their physician to see if it is the best course of action when dealing with a herniated disc. If you decide on having ACDF performed, trust in your physician, and make sure you adhere to any restrictions and advice given during the recovery process.