Anterior Cervical Discectomy and Fusion (ACDF) is a surgical procedure designed to alleviate pain in the neck and arms. It addresses issues in the cervical spine, involving the removal of a damaged disc from between two vertebrae. A specialized component, often referred to as a “cage,” is then inserted into the space where the disc was removed. This cage helps facilitate the fusion of the vertebrae, aiming to stabilize the neck and relieve pressure on nerves.
Understanding ACDF and the Cage
ACDF stands for Anterior Cervical Discectomy and Fusion, a procedure accessing the spine from the front of the neck. The “discectomy” refers to the surgical removal of a damaged intervertebral disc. These discs cushion the vertebrae; when compromised, they can press on nerves or the spinal cord, causing pain, numbness, or weakness.
Following disc removal, a specialized interbody cage, or spacer, is inserted into the empty disc space. These cages are made from materials such as polyetheretherketone (PEEK) or titanium. They are hollow or porous, allowing them to be filled with bone graft material. The cage’s primary function is to maintain the space between the vertebrae, preventing collapse. It also provides immediate structural stability and acts as a scaffold, encouraging new bone to grow through and around it, leading to a solid fusion between adjacent vertebrae over several months.
Conditions Treated by ACDF
ACDF surgery is a common treatment for various conditions affecting the cervical spine. A herniated cervical disc, where soft inner material pushes through its outer wall, can compress nerve roots or the spinal cord. This compression leads to symptoms like radiating arm pain, tingling sensations, numbness, or weakness in the arm or hand.
Cervical spinal stenosis, a narrowing of the spinal canal in the neck, also often necessitates ACDF. This narrowing can be caused by bone spurs (osteophytes) or thickened ligaments that pressure the spinal cord and nerves. Degenerative disc disease, where discs dry out and shrink, also causes nerve compression and pain. By removing the problematic disc or bone spurs and fusing the vertebrae, the procedure aims to relieve this pressure, alleviating associated symptoms.
The ACDF Surgical Process
The ACDF surgical process begins with the patient under general anesthesia. The surgeon makes an incision, usually about two inches, on the front or side of the neck. This anterior approach allows direct access to the cervical discs without disturbing the spinal cord, spinal nerves, or major neck muscles. Once the neck muscles, trachea, and esophagus are moved aside, the damaged disc and surrounding vertebrae are exposed.
The surgeon removes the damaged intervertebral disc, along with any bone spurs or disc fragments pressing on the spinal nerves or spinal cord. After the disc is removed, the empty space between the vertebrae needs to be stabilized. The ACDF cage, often pre-filled with bone graft material (which can be the patient’s own bone, donor bone, or synthetic material), is inserted into the cleared disc space. The cage maintains the disc height and alignment. A metal plate and screws are often used to secure the cage and stabilize the vertebrae, providing immediate rigidity while the bone fusion process begins.
Recovery and Potential Considerations
Following ACDF surgery, patients typically have a short hospital stay, often one to three days. Pain management is provided, and patients are advised to limit certain activities for proper healing. The fusion process, where bone graft material within and around the cage joins adjacent vertebrae into one solid bone, can take several months, commonly three to twelve months. The cage acts as a supportive bridge during this time.
During recovery, some individuals may experience temporary swallowing difficulties (dysphagia) or a sore throat due to the surgical approach. Non-union, where vertebrae do not fully fuse, is a consideration that may require further intervention. Nerve irritation, though less common, can also occur, causing persistent numbness or weakness. Infection at the surgical site is a possible consideration.