The procedure starts with a transverse or oblique incision along a skin crease in the anterior neck. Careful dissection is performed to avoid injury to crucial neurovascular structures such as the carotid artery, jugular vein, and vagus nerve. The prevertebral fascia is opened to expose the affected cervical vertebrae, typically using intraoperative radiographic guidance for precise localization.

Once the target disc is identified, the discectomy is performed. The entire disc and any osteophytes compressing the nerve roots or spinal cord are removed. Foraminotomy may also be performed if necessary, to ensure decompression of exiting nerve roots.

In anterior cervical discectomy with Fusion (ACDF), the discectomy is followed by the placement of a bone graft or a cage in the intervertebral space to promote fusion between adjacent vertebrae. Instrumentation such as plates and screws are often used for immediate stabilization. This fusion prevents segmental instability and maintains cervical alignment but reduces motion at the operated level.

In cases where motion preservation is a priority, Artificial Disc Replacement (ADR) is an alternative to fusion. A synthetic disc is inserted into the disc space to preserve normal neck motion and potentially reduce the risk of adjacent segment disease, a known long-term complication of fusion procedures.

The anterior approach requires meticulous surgical skills to avoid complications. The recurrent laryngeal nerve, running close to the operative field, is at risk; damage can lead to vocal cord paralysis and hoarseness. The risk of damage to the esophagus and trachea also warrants careful consideration.

Postoperatively, patients are typically managed with pain medications and may require a cervical collar for stabilization. Physical therapy is recommended to strengthen neck muscles and improve range of motion. The success rate of Anterior cervical discectomy is high, with most patients experiencing significant relief from symptoms.