Anterior Cervical Discectomy and Fusion - ACDF
Removal of the slipped disc through the front of the neck. Fusion: a cage or bone graft is inserted to replace the removed disc. A plate might be added in some cases for additional stability.
Decompression of spinal cord (myelopathy) and nerve roots (radiculopathy). Fusion: stabilisation of the spine. The operation usually does not improve neck pain unless there is proven instability. Neck pain is often due to wear and tear and the operation will not change this.
Infection, bleeding, cerebrospinal fluid leak, neurological damage including paralysis, hoarse voice which is usually transient but can be permanent, stroke, no improvement of symptoms, death in cases of high cervical cord injuries, failure of the inserted cage or plate. Overall, it is a standard and safe procedure, which has small but potentially very serious risks.
24-48 hours after operation in majority of cases
Always general anaesthesia
The neck might feel sore for a short time and sometimes can radiate between the shoulder blades. Patients can experience slight discomfort when swallowing for a few days after the operation. A collar is not routinely necessary post operatively
Commonly asked questions
When do I need fusion?
If there is proven instability, which can be seen on x-rays when bending the head forward and backwards then a fusion is required. Inserting a cage also restores the normal curvature of the spine and can prevent the ‘collapse’ of the disc space which could lead to nerve entrapment. However, there is no clear evidence that inserting a cage is associated per se with a better outcome. In my practice, it is decided in each case individually.
What are the long-term effects?
Fusion of a single or even two segments in the cervical spine usually does not lead to any significant reduction in mobility. This is because the other discs often compensate for the lost movement, which can lead to excessive wear and tear years after the operation (so called adjacent level disease). There are no good data to give an indication to what extend this might happen and it is impossible to predict this as the majority of patients who had a fusion will not develop this problem. However, this is the reason why disc replacements instead of a fusion might be better in some cases.