Anterior Cervical Discectomy and Fusion (ACDF)

Dr. Lauren Boden, M.D., may recommend Anterior Cervical Discectomy and Fusion (ACDF) to relieve symptoms caused by cervical spine conditions. The decision to proceed with ACDF is based on a thorough evaluation of a patient’s symptoms, imaging studies, and overall health. Dr. Boden will try to help her patients improve with conservative treatment options like physical therapy, medications, and injections. When these treatments do not provide adequate relief of symptoms, she may recommend the surgery for the following reasons:

Herniated Disc

A herniated disc occurs when the inner portion of a spinal disc pushes through its outer ring layer, compressing nearby nerves and causing pain, weakness, numbness, or tingling in the neck, shoulders, arms, and hands.

Cervical Radiculopathy

This condition occurs when a nerve in the neck is pinched or irritated, leading to radiating pain, weakness, or numbness in the arms or hands. This can be from a herniated disc or from degenerative changes, arthritis, and bone spurs. ACDF removes the source of nerve compression and helps restore normal function by allowing the compressed nerves space to heal.

Cervical Spinal Stenosis and Myelopathy

Spinal stenosis is a narrowing of the spinal canal that can compress the spinal cord and nerve roots. This condition can lead to neck pain, arm pain, numbness, and difficulty with balance or coordination. Cervical myelopathy often presents without pain, but can damage the spinal cord and lead to issues with hand numbness, loss of fine motor skills in the hands, and trouble with balance and gait. If left untreated, it can progress over time and lead to urinary retention. ACDF can help by relieving the pressure on the spinal cord and nerve roots.

Traumatic Injuries and Fractures

Spinal trauma, such as fractures or instability due to an accident, may require surgical intervention. ACDF can stabilize the spine and prevent further complications.

ACDF is performed under general anesthesia and typically takes one to three hours, depending on the complexity of the case and the number of levels involved.

Anterior Approach

The patient is brought to the operating room and positioned on their back. After the anesthesia team gets the patient to sleep under general anesthesia, a small incision is made over the front of the neck. The surgeon uses a safe window between the muscles, nerves, and blood vessels in the outer aspect of the neck and the breathing and feeding tubes more centrally to expose the spine. Special retractors are placed to protect these important structures and allow Dr. Boden to visualize the spine.

Removal of the Damaged Disc (Discectomy)

Using specialized surgical tools, the damaged or herniated disc is carefully removed, relieving pressure on the spinal cord and nerves. Bone spurs, thickened ligaments, or other obstructions may also be removed to ensure adequate decompression of the spinal cord and nerve roots.

Insertion of Spacer and Bone Graft

After removing the disc, a spacer is placed in the empty disc space to maintain proper spine alignment. Thisr spacer restores the proper disc space height and lordosis of the spine to maintain the decompression. The spacer is typically either made of bone or a metal or plastic cage and is filled with bone graft or synthetic material to help with the healing process and promotes fusion between the adjacent vertebrae.

Fusion and Stabilization

To stabilize the spine, a small metal plate and screws are placed over the treated area. These components help ensure the spacer stays in place while the vertebrae heal and fuse together.

Closure and Recovery

The incision is closed with absorbable sutures, and the patient is moved to a recovery area. Most patients will spend one night in the hospital for monitoring, though some may leave the same day after several hours of observation.

Recovery from ACDF varies depending on the patient’s overall health, the number of treated vertebrae, and adherence to post-surgical guidelines. Dr. Boden will provide postop instructions to follow after surgery. They may include:

• Taking pain medications including tylenol, a muscle relaxer, and a short course of stronger pain medication as needed.
• A soft  cervical collar may be provided for comfort. Avoiding heavy lifting, twisting, or excessive bending for six weeks after surgery.
• Bone fusion typically takes several months to complete. Follow-up X-rays or imaging scans will be performed to assess fusion progress.
• A structured physical therapy program helps restore strength, flexibility, and posture.

Benefits

• Significant relief of radicular pain
• Reduced nerve compression symptoms (numbness, weakness)
• Long-term spinal stability and improved quality of life
• Minimally invasive approach with a relatively quick recovery

Risks

As with any surgery ACDF carries some risks, including:

• Infection or bleeding
• Difficulty swallowing or hoarseness (temporary)
• Fusion failure (pseudoarthrosis)
• Adjacent segment disease (wear and tear on nearby vertebrae)

Dr. Lauren Boden, M.D., evaluates each patient’s condition to determine if ACDF is the best treatment option. Non-surgical approaches, such as physical therapy, medications, and injections, are often explored before considering surgery. However, for patients with severe nerve compression, persistent pain, or spinal instability, ACDF offers a proven, effective solution.