What is ACDF Surgery?
ACDF stands for Anterior Cervical Discectomy and Fusion, it is a type of neck surgery that involves removing a damaged disc to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness, and tingling.
A= Anterior : Which means ‘front’. This clearly means that the ACDF surgery is done from the front of the neck.
C= Cervical: Meaning neck. This suggests that the ACDF surgery is performed on the neck.
D= Discectomy: A discectomy is performed, meaning removal of the intervertebral disc.
F= Fusion: This refers to the joining of two or more neck bones together at the end of the operation, in order to ensure stability.
Why Do You Need An ACDF Surgery?
There may be various reasons for the ACDF surgery. An Anterior Cervical Discectomy and Fusion surgery may be suggested to you for a variety of problems like degenerative disorders, trauma, or instability. Symptoms of neural (nerve or spinal cord) compression include pain, aching, stiffness, numbness, tingling sensations, and weakness. As spinal nerves branch out to form the peripheral nerves, these symptoms may radiate into other parts of the body. For example, cervical nerve root compression (pinched nerves in the neck) can cause symptoms in the shoulders, arms, and hands.
An ACDF surgery is usually recommended after failing all the conservative measures like neck collars, physical therapy, pain medications, and nerve sheath injections. In cases of significant instability or neurological problems, a ACDF surgery may be the most appropriate treatment option.
Who is a Suitable Candidate for ACDF Surgery?
People who have one or more of the following symptoms are considered to be good candidates for an ACDF Surgery:
- Significant weakness in your hand or arm
- Arm pain worse than neck pain
- Symptoms that have not improved with conservative treatments like physical therapy or medication makes you an ideal candidate for ACDF surgery.
- Aching, stiffness, numbness, tingling sensations, and weakness.
Benefits of ACDF Surgery
Anterior approach has many benefits. Anterior Approach in ACDF surgery allows direct visualization to the disc. The anterior approach is beneficial because it can provide access to almost the entire cervical spine, from the C2 segment at the top of the neck down to the cervicothoracic junction, called the C7-T1 level, which is where the cervical spine joins with the upper spine.
Spine surgeons often prefer this approach because it provides access to the spine through a relatively uncomplicated pathway. ACDF surgery is beneficial to the patient because the patient tends to have less incisional pain from this approach than from a posterior operation.
ACDF Surgery Procedure or How is ACDF Surgery Done?
During ACDF surgery, your surgeon makes a small incision in the front of the neck directly over the disc and creates a pathway to the spine by moving the muscles to the side. This pathway will expose the damaged disc. The surgeon will first remove any bone spurs and disc fragments pressing on the nerves or spinal cord. To repair the damaged disc, the surgeon then inserts an implant into the space between the vertebrae. Your surgeon may choose to use either an implant made from synthetic material or from actual bone. This implant acts as a support between the two vertebrae to hold them in place while they heal. In order to stimulate fusion and healing of the bone, the surgeon will insert bone graft or other special materials into the disc space. Finally, the surgeon may need to further strengthen the reconstruction with the addition of a small metal plate and screws. This extra support may aid in bone healing. The surgeon then completes the ACDF surgery procedure by closing the incision area, and may choose to place a small drain at the site for a day or two. Over several months, the vertebral bones and the bone graft material inside the implant will fuse together and become one solid block.
What to Expect Before the ACDF Surgery?
Your surgeon may ask you about your medical history in order to identify anything that may affect conditions for anesthesia and bone healing. They may also take care of your diet prior to surgery, so they usually recommend a diet rich in calcium, vitamin D, and protein as it helps in bone healing. In addition, you may be asked to completely stop nicotine addictions like smoking and tobacco at least 4 weeks prior and several months after the ACDF surgery as nicotine impairs bone healing. You may also be asked to avoid alcohol and caffeine as they can cause bleeding problems during and after the ACDF Surgery.
Your surgeon may tell you about some medications that should not be taken prior to and 6 months after the procedure e.g. aspirin, ibuprofen, Advil, Motrin, Nuprin; naproxen sodium, Aleve etc. NSAIDs may cause bleeding and interfere with bone healing.
Diagnostic Tests That Are Done Before ACDF Surgery:
Disorders that can cause nerve root compression include spinal stenosis, degenerative disc disease, a bulging or prolapsed intervertebral disc, bony spurs (osteophytes), or spondylosis (osteoarthritis of the spine). Commonly, two or more of these conditions are seen together. These problems can be diagnosed by the following diagnostic studies:
X-rays: Plain X-rays don’t detect herniated disks, but they may be performed to rule out other causes of back pain, such as an infection, tumor, spinal alignment issues or a broken bone.
CT scan: A CT scanner takes a series of X-rays from many different directions and then combines them to create cross-sectional images of your spinal column and the structures around it.
MRI: This test can be used to confirm the location of the herniated disk and to see which nerves are affected. A very effective test to diagnose a herniated disk. In this study, radio waves and a strong magnetic field are used to create images of internal structures of your body.
Myelogram: This test can show pressure on your spinal cord or nerves due to multiple herniated disks or other conditions. In this stury, a dye is injected into the spinal fluid and X-rays are taken.
Nerve tests: Electromyograms and nerve conduction studies measure how well electrical impulses are moving along nerve tissue. This can help pinpoint the location of the nerve damage.
What are the Risks of the ACDF Surgery?
Risks include infections, inadequate bone healing, loosening of the screws, cage implant, or persistent pain from scar tissue, very rarely problems with swallowing and speaking, and risk of paralysis.
Recovery Period Following ACDF Surgery?
Initial recovery following ACDF surgery generally lasts for about 4 weeks. Intermittent x-rays are taken to see the progress of healing and for the surgeon to decide when you can return to your activities of daily living following ACDF surgery.
For the first few weeks after ACDF surgery, heavy lifting and heavy household chores are discouraged. A cervical collar can be worn to stop the motion and help in faster recovery following ACDF surgery. Physical therapy may be advised. It takes about 3 to 6 months for the bone to heal completely following ACDF surgery.
ACDF (Anterior cervical discectomy and fusion) surgery is successful in relieving arm pain in 92 to 100% of patients. However, arm weakness and numbness may persist for weeks to months following ACDF surgery. Neck pain is relieved in 73 to 83% of patients who undergo ACDF surgery. In general, people with arm pain benefit more from ACDF than those with neck pain.
It is important to keep a positive attitude and diligently perform your physical therapy exercises following ACDF surgery for faster recovery. You must understand all the aspects of the ACDF surgery before undergoing an intervention and choose it wisely. The ACDF surgery has a high success rate and brings a lot of positive changes in your lifestyle post surgery.