Anterior Cervical Discectomy and Fusion
What is it?
Anterior Cervical Discectomy and Fusion (ACDF) is a standard surgical procedure to relieve spinal cord or nerve root pressure in the cervical spine, typically caused by herniated discs, degenerative disc disease, or spondylosis. The procedure is particularly indicated for patients presenting with radiculopathy, myelopathy, or both, where conservative treatments have not provided adequate relief.
ACDF is typically favored for its direct approach to the pathology, reduced postoperative pain (compared to posterior approaches), and high success rate in alleviating symptoms and restoring function. Most patients experience significant relief from their preoperative symptoms, and the fusion process usually leads to a stable and aligned cervical spine.
Postoperatively, patients may be instructed to wear a cervical collar for a period and engage in physical therapy to regain strength and mobility. Radiographic follow-up is essential to assess the success of the fusion.
Procedure
ACDF involves an anterior approach to the cervical spine. The procedure starts with a discectomy, which entails the removal of the degenerated disc material that is compressing the neural structures. Following the discectomy, the spinal fusion process begins. This involves placing a bone graft or a bone graft substitute in the intervertebral space where the disc was removed. The graft material can be autograft (from the patient), allograft (donor bone), or synthetic substitutes.
The primary purpose of the fusion is to provide stability to the affected segment and prevent abnormal motion. To enhance the stability and success of the fusion, metallic hardware such as plates and screws are often used. This instrumentation immediately stabilizes the spine and promotes the fusion process.
The anterior approach to the cervical spine necessitates careful navigation around vital structures, including the esophagus, trachea, and major blood vessels. Intraoperative imaging assists in ensuring precise placement of the graft and instrumentation. Neuromonitoring may be employed to safeguard the integrity of the spinal cord and nerves.