Anterior Cervical Discectomy and Fusion (ACDF)

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.