ACDF Procedure

Anterior Cervical Discectomy And Fusion is a combination surgical operation. This is because it combines two operations which are carried out almost concurrently. Anterior Cervical Discectomy is usually the first one. It is the surgical removal of an offending disc, which is basically a cervical disc herniation. The cervical herniated disc puts pressure on the nerve root or spinal cord. This causes pain, numbness, weakness and tingling. The anterior operation, which is done from the front of the neck, is meant to relieve the pressure, hence accompanying pain. It can also be referred to as Anterior Cervical Decompression, owing to the fact that discectomy is one of the many forms of surgical decompression.

The second one is the Fusion Surgery. The main purpose of this surgery is to ensure the cervical segment is stable. It goes hand in hand with the discectomy. In fact, they are done almost at the same time.

The ACDF treatment is not only done to treat cervical herniated disc; It can also be used to treat several other conditions, especially cervical degenerative disc disease. It is not restricted to only one level of the cervical spine. It can be applied to several other levels too.

Anterior Approach vs Posterior Approach: Which is the best And Why?

The anterior approach means that the operation is carried out through the front of the neck. The approach has two main advantages over the approach from the back of the neck. First, the spine is more easily accessible through the front than through the back. Secondly, the neck front approach leads to reduced post surgery pain. This is because of the less complicated operative pathway. The main post surgery problem faced by patients who undergo the operation is difficulty in swallowing for a period of between two to five days.

The Procedure Below are the steps followed during the operation:

The Neck Front Approach: A one to two inch horizontal skin incision is made either to the left or right side of the neck. This is followed by the splitting of the Platysma muscle in line with the incision, before entering the sternocleidomastoid and strap muscles. After this, the surgeon enters the plane between the carotid sheath and the trachea/ esophagus.
Removal of the Disc: This involves the insertion of a needle into the disc space. An X-ray is done to show the actual position of the needle. Once the X-ray has identified the correct disc space, removal of the appropriate portions follows. The outer annulus fibrosis is cut, before the removal of the nucleus pulposus. Though not all of the disc is removed, much of is removed.
Decompression Of The Canal: This involves the front to back dissection of the posterior longitudinal ligament. Removal of the ligament allows access and removal of any oesteophites or any remaining disc material extruding through the ligament. This stage involves use of a surgical microscope or magnifying loupes for visualizing invisible anatomic structures.
The Cervical Fusion: It involves inserting a bone graft in the empty disc space. It serves several purposes: It prevents the collapse of the disc space while promoting growth of the two vertebrae into one unit. It also prevents local deformity, also called kyphosis while ensuring there is sufficient room for the spinal cord and nerve roots.

Patients leave the hospital the same day on which they are operated or after a single night. Healing takes between four to six weeks after the operation. However, the fusion takes up to eighteen months to be fully set up. It is vital for patients to discuss with their surgeon any activity restrictions.