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Anterior Cervical Discectomy and Fusion (ACDF)

Anterior Cervical Discectomy and Fusion (ACDF)

Anterior Cervical Discectomy and Fusion (ACDF) is a surgical procedure performed on the cervical spine, specifically the neck. This surgery involves an anterior approach, where the surgeon accesses the cervical spine through the front of the neck, avoiding disruption to the muscles in the back. During the procedure, the surgeon removes the damaged or herniated disc that is causing compression on the spinal cord or nerve roots. This discectomy aims to alleviate pressure and relieve symptoms such as pain, numbness, or weakness. Following the removal of the disc, the adjacent vertebrae are fused together using a bone graft, either from the patient’s own body or a donor.

Procedures

Chiari Decompression
Cervical Laminoplasty
Minimally Invasive Cervical Laminoforaminotomy
Posterior Cervical Laminectomy/ Fusion
Cervical Arthroplasty / Cervical Disc Replacement

Related Articles

ACDF Patient Education Animation

ACDF Overview

ACDF 3D Animation

Surgery Step by Step Process

The Anterior Cervical Discectomy and Fusion (ACDF) surgical procedure is a common intervention used to treat cervical spine conditions such as degenerative disc disease, herniated discs, and spinal cord compression. This procedure involves removing the damaged disc material from the cervical spine and fusing the adjacent vertebrae together to stabilize the spine. Below is a step-by-step overview of the ACDF surgical procedure:

  1. Preoperative Preparation: Before the surgery, the patient undergoes a thorough evaluation, including a history and physical examination, as well as radiographic imaging such as X-rays, MRI, or CT scans. Informed consent is obtained, detailing the procedure, potential risks, and benefits. The patient may also meet with an anesthesiologist to discuss anesthesia options and receive instructions for fasting prior to surgery.
  2. Patient Positioning and Anesthesia: Once in the operating room, the patient is placed in a supine position on the operating table. If necessary, a cervical collar may be placed to stabilize the neck. Anesthesia is induced either through general anesthesia or local anesthesia with sedation, depending on the patient’s condition and the surgeon’s preference. Endotracheal intubation or other airway management techniques may be employed to maintain a patent airway during surgery.
  3. Surgical Approach: A midline incision is made over the anterior aspect of the neck, typically spanning one or more cervical levels depending on the extent of the pathology. The surgeon carefully dissects through the subcutaneous tissue and platysma muscle to expose the cervical spine. Retraction devices are used to gently retract the esophagus, trachea, and carotid sheath laterally, providing access to the target vertebral levels.
  4. Decompression and Discectomy: Once the target levels are identified using fluoroscopy, the surgeon proceeds with the decompression and discectomy. The anterior longitudinal ligament is incised, and the disc material is carefully removed using specialized instruments such as microscopes and curettes. Any disc fragments or osteophytes compressing the spinal cord or nerve roots are meticulously dissected and removed to alleviate neural compression and restore spinal stability.
  5. Fusion Procedure: With the disc space cleared, the surgeon prepares the vertebral endplates by removing cartilage and thoroughly decorticating the bone to promote fusion. Bone graft material, either autograft harvested from the patient’s own body or allograft or synthetic substitutes, is then packed into the disc space and along the vertebral bodies. In some cases, anterior cervical plates, screws, or cages may be used to provide additional stability and support for fusion.
  6. Closure: Once the fusion procedure is completed, the surgeon ensures hemostasis by inspecting for any bleeding vessels and using hemostatic agents or electrocautery as needed. The incision is then closed in layers, with sutures or staples used to approximate the subcutaneous tissue and skin. A sterile dressing is applied over the incision site, and in some cases, a surgical drain may be placed to prevent fluid accumulation. Finally, a cervical collar may be fitted to immobilize the neck during the initial stages of recovery.
  7. Postoperative Care: Following surgery, the patient is closely monitored in the recovery room for vital signs, neurologic status, and pain management. Depending on the complexity of the procedure and the patient’s overall health, a hospital stay may be required for observation and rehabilitation. Physical therapy and early mobilization are initiated to promote recovery and optimize outcomes. Follow-up appointments with the surgeon are scheduled to monitor healing progress, assess fusion on imaging studies, and address any postoperative concerns or complications.

In conclusion, the Anterior Cervical Discectomy and Fusion (ACDF) surgical procedure is a meticulous intervention aimed at relieving cervical spine pathology and restoring spinal stability. By following a systematic approach and employing advanced surgical techniques, surgeons can effectively address a wide range of cervical spine disorders and help patients achieve improved function and quality of life.

Clinical outcome in patients undergoing (ACDF) for axial neck pain(Anterior cervical discectomy and fusion for the management of axial neck pain in the absence of radiculopathy or myelopathy) Anterior cervical discectomy and fusion (ACDF) is a proven, effective treatment for relieving neck pain due to degenerative conditions of the cervical spine. Since most patients also present with radiculopathy or myelopathy, little is known as to the effectiveness of ACDF to relieve pain and improve function in patients without radicular or myelopathic symptoms.
Top 100 most cited articles on anterior cervical discectomy and fusion Anterior cervical discectomy and fusion (ACDF) is a typical surgical method in spine surgery and has progressed significantly in the last several decades. The purpose of this study is to determine how the 100 most-cited original articles on ACDF have been the most influential in this field by identifying and analyzing them.
Anterior cervical discectomy with fusion in patients with cervical disc degeneration(A prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage)) Anterior cervical discectomy with fusion (ACDF) is challenging with respect to both patient selection and choice of surgical procedure. The aim of this study was to evaluate the clinical outcome of ACDF, with respect to both patient selection and choice of surgical procedure: fusion with an autologous iliac crest graft (AICG) versus fusion with an artificial cage made of polyetheretherketone (PEEK).
Long-term results comparison after anterior cervical discectomy with BGS-7 spacer (NOVOMAX®-C) and allograft spacer: A prospective observational study In an anterior cervical discectomy and fusion (ACDF), various types of graft materials including autograft, allograft, and synthetic graft have been used to achieve adequate spinal fusion. Allograft spacer is mainly used in cervical fusion, especially in the anterior approach. The synthetic bone graft material BGS-7(CaO-SiO2-P2O5-B2O3, bioactive Glass-Ceramics) can bind with surrounding bone tissue by forming a hydroxyapatite layer bone bridge, leading to faster graft osseointegration. This study was conducted to compare long-term clinical outcome of BGS-7 spacer and allograft spacer for anterior cervical discectomy and fusion surgery.

What is Anterior Cervical Discectomy and Fusion (ACDF)?

ACDF is a surgical procedure performed on the cervical (neck) spine to relieve pressure on the spinal cord and nerves caused by a herniated disc or bone spurs. It involves removing the damaged disc and fusing the adjacent vertebrae with bone grafts or implants.

The primary goal of this procedure is to relieve pressure on either the nerve roots or spinal cord and/or treat an unhealthy disc in the cervical spine.

The unhealthy disc is removed, via discectomy, and replaced with an interbody fusion implant. A plate, spacer, and screws construct, or an integrated plate-spacer with ixation (i.e., screws or anchors), may be used to hold the vertebrae in place while fusion (joining of two bones) occurs.

Why and How is ACDF performed?

ACDF is performed to alleviate symptoms such as neck and arm pain, numbness, weakness, and tingling caused by compression of the spinal cord or nerves due to disc herniation, degenerative disc disease, or spinal stenosis.

A small horizontal incision (a surgical cut made in skin) is made in the anterior (front) of the neck to either the left or right of the center.
The soft tissues of the neck are gently separated to allow access to the surgical site. Surgical instruments are used to remove the intervertebral disc and decompress (relieve pressure on) the nerve structures.

To fill the vacant disc space and join the vertebrae together, an interbody fusion implant is used. If a combination of a spacer and a plate is used, the spacer is placed into the disc space with the plate placed over top to hold it in place and screws are inserted through the plate into the upper and lower vertebrae. Or, if an integrated platespacer implant is used, the implant is placed into the disc space and fixation hardware, screws in the below example, are inserted to secure the implant in place.

Over time, the vertebrae can grow together through fusion. This process varies among patients and can take anywhere from a few months to a year.

How long does the surgery take?

The duration of ACDF surgery typically ranges from 1 to 2 hours, but it can vary depending on factors such as the number of levels involved and the complexity of the procedure.

What is the recovery time for ACDF surgery?

Recovery time varies from person to person, but most individuals can expect to return to light activities within a few weeks and resume normal activities within 6 to 12 weeks. However, full recovery may take several months.

Will I need to wear a neck brace after surgery?

In some cases, a neck brace may be prescribed to provide support and stability to the neck during the initial stages of healing. The duration and necessity of wearing a brace depend on the surgeon’s recommendation and individual circumstances.

How long does it take for the fusion to occur?

Fusion typically takes several months to occur. The bone graft or implants create a bridge between the vertebrae, and over time, new bone forms, eventually solidifying the fusion. X-rays or other imaging studies may be done to monitor the fusion progress.

When can I return to work after ACDF surgery?

The timing of returning to work depends on various factors, including the type of work you do and the extent of your surgery. Typically, individuals with sedentary jobs may return to work within a few weeks, while those with physically demanding jobs may need more time off.

Are there any long-term restrictions or lifestyle changes after ACDF surgery?

Your surgeon may recommend avoiding certain activities that put stress on the neck, such as heavy lifting or high-impact sports. It’s essential to follow post-operative guidelines and participate in physical therapy to optimize recovery and minimize the risk of complications.

What is Anterior Cervical Discectomy and Fusion (ACDF)?

ACDF is a surgical procedure performed on the cervical (neck) spine to relieve pressure on the spinal cord and nerves caused by a herniated disc or bone spurs. It involves removing the damaged disc and fusing the adjacent vertebrae with bone grafts or implants.

What is Anterior Cervical Discectomy and Fusion (ACDF)?

ACDF is a surgical procedure performed on the cervical (neck) spine to relieve pressure on the spinal cord and nerves caused by a herniated disc or bone spurs. It involves removing the damaged disc and fusing the adjacent vertebrae with bone grafts or implants.

Additionally, a metal plate and screws are often employed to stabilize the spine during the fusion process. The instrumentation provides stability and support for proper alignment during the healing period. ACDF is commonly recommended for conditions like herniated discs, degenerative disc disease, and cervical radiculopathy. The ultimate goal of ACDF is to alleviate pain, improve neurological symptoms, and stabilize the cervical spine, promoting a return to a more active and pain-free lifestyle. Recovery and rehabilitation after ACDF vary among individuals, and the decision to undergo this procedure should be made in consultation with a qualified healthcare professional after a thorough evaluation of the patient’s specific condition

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Conditions Related To ACDF

Kyphosis

Kyphosis is a medical term used to describe an excessive outward curvature of the spine, leading to a forward rounding or hump-like appearance in the upper back or thoracic region.

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Radiculopathy

Cervical radiculopathy is a condition characterized by compression or irritation of the nerve roots in the cervical spine (neck region). This compression can result in pain, numbness, tingling, or weakness that radiates into the arms.

Read more

Myelopathy

Cervical myelopathy is a condition characterized by dysfunction of the spinal cord in the neck region, specifically in the cervical spine. It is often caused by compression or narrowing of the spinal canal, leading to a range of neurological symptoms.

Read more

Cervical Stenosis

Cervical stenosis refers to the narrowing of the spinal canal in the neck region, known as the cervical spine. This narrowing can put pressure on the spinal cord and nerve roots, leading to a variety of symptoms.

Read more

Headaches

Headaches are a common and often disruptive condition that can vary in intensity, duration, and cause. They can stem from a variety of factors, and understanding the different types of headaches can be crucial for effective management.

Read more

Neck Pain/Stiffness

Neck pain and stiffness are common symptoms that many individuals experience at some point in their lives. These symptoms can arise from various causes, ranging from muscle strain to underlying medical conditions.

Read more

Herniated Disc

Cervical herniated disc is a condition that occurs when the outer layer of a disc in the neck region tears, causing the inner material to protrude and potentially irritate nearby nerves.

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