Anterior cervical discectomy and fusion (ACDF) is a surgery to remove a herniated or degenerative disk of the spine. The surgeon makes an incision in the throat area, entering from the front (anterior), and moves aside your neck muscles, trachea and esophagus to access the spine. For cervical (neck) spinal surgeries, entering from the front lets your physician work without disturbing the spinal cord, spinal nerves or back muscles.

A discectomy may be either single-level or multi-level:

• Single-level: One disk is removed
• Multi-level: Multiple disks are removed

Once removed, the space between vertebrae must be filled. A bone graft is usually done to prevent the vertebrae from collapsing. Your surgeon will fuse the bone graft to the other vertebrae with metal plates and screws. New bones cells will grow over the hardware as the bone heals.

There are three types of bone grafts used in ACDF:

• Autograft: Bone comes from you, usually from the hip (iliac crest), which has a higher number of bone-growing cells and proteins
• Allograft: Bone comes from a donor (cadaver)
• Artificial: Uses manmade plastic, ceramic or other compounds

Autograft is the “gold standard” for rapid healing and spinal fusion, but harvesting bone cells can be painful.

Spinal fusion may produce some loss of motion, particularly in a multi-level discectomy. Artificial disks may preserve the neck's range of motion.

When to get ACDF

Most herniated disk injuries heal a few months after nonsurgical treatment. When the pain is significant enough, and nonsurgical options have not relieved it, surgery may be considered.

ACDF may help when physical therapy or medication have not relieved pain or weakness in arms or hands. It may also be recommended for people who have herniated or degenerative disk disorder.

A neurosurgeon, orthopaedic surgeon or spine surgeon may perform the surgery.

Stop smoking

One of the most important things you can do to help your spine surgery be successful is to quit smoking, if you smoke. Spinal fusion fails in as many as 40 percent of smokers, compared with only 8 percent of nonsmokers.

Nicotine prevents bone growth and can cause complications that lead to failed bone fusion. Smoking also inhibits blood circulation, which slows wound healing.

Northwestern Medicine offers a Smoking Cessation Program that can help you quit smoking before your surgery.

After surgery

It's important for your bone to heal well, which is why you'll have several restrictions after an ACDF. The following is a list of things to avoid post surgery. Do not:

• Take any non-steroidal anti-inflammatory drugs (NSAIDs, like aspirin, ibuprofen, Advil®, Motrin®, Nuprin®, Aleve®) for six months after surgery. NSAIDs may cause bleeding and may interfere with bone healing
• Smoke
• Drive for two to four weeks after surgery; wait for your surgeon's approval
• Lift anything heavier than five pounds
• Do house or yard work (including gardening; mowing; vacuuming; ironing; or loading/unloading the dishwasher, washer or dryer)
• Sit for long periods of time
• Bend your head forward or backward
• Have sex until your surgeon says otherwise

Complications

ACDF, like all spinal surgery, has some potential complications. Some people have temporary arm numbness and weakness that lasts for weeks or months. Other complications include:

• Hoarseness and/or trouble swallowing: The recurrent laryngeal nerve may be affected during surgery, which can cause temporary hoarseness or swallowing difficulties as the nerve recovers
• Instrumentation fracture: The screws, plates and rods used to stabilize the spine (instrumentation) may move or break before spinal fusion is complete; this may require additional surgery to repair
• Failure of spinal fusion: Smoking and other lifestyle factors like obesity and malnutrition can adversely affect spinal fusion
• Transitional syndrome: Also known as adjacent-segment disease, this is when adjacent vertebrae undergo increased stress in the wake of fusion, and suffer degeneration, which can cause pain
• Bone graft migration: Rarely, the bone graft can move into an incorrect position. This can happen if the instrumentation is not used to secure the graft, and is more common in multi-level ACDF
• Nerve damage: Spinal surgery always carries some risk of nerve or spinal cord damage, including numbness and paralysis. In many cases, nerve damage from the herniated disk can cause persistent pain

Favorable outcomes

Most people who have ACDF are relieved from the chronic pain of their condition, particularly arm pain. Neck pain is also relieved, although usually less significantly than arm pain.

Spinal fusion is likelier to occur with ACDF, bone graft and use of instrumentation.