ACDF (Anterior Cervical Discectomy & Fusion) Surgery

What is ACDF surgery?

Anterior cervical discectomy and fusion (ACDF surgery) is a procedure that treats issues in your neck through the front or your throat area. ACDF surgery can remove pressure on your nerves and/or your spinal cord in your neck. It also helps manage certain types of arthritis that may cause significant pain.

You may hear your surgeon refer to ACDF surgery as cervical fusion or neck fusion.

What does ACDF surgery treat or manage?

ACDF surgery takes the pressure off nerves around your spinal cord in your neck. The pressure is usually caused by bone spurs and bulging disks. Bone spurs develop as a result of arthritis. Disks act as shock absorbers between vertebrae that can slip out of place and move up against a nerve.

ACDF surgery can also help if you experience progressive weakness or have damage to your spinal cord. You may develop these problems after serious accidents or with other conditions.

The pressure on your nerves or spinal cord is usually something that builds up over a long period of time.

Who is a good candidate for ACDF surgery?

A healthcare provider may recommend ACDF surgery if nonsurgical treatment options to manage the following symptoms don’t work:

• Pain going down your arms.
• Tingling and numbness in your hands and fingers.
• Weakness in your hands and arms.
• Trouble with balance and walking.
• Severe neck pain.

Nonsurgical treatment options could include:

• Physical therapy.
• Heat and ice.
• Over-the-counter medications.
• Injections (epidural steroid injections).

It’s important to remember that just because you have one or more of these symptoms doesn’t mean you need surgery. If surgery isn’t recommended, it doesn’t mean your surgeon doesn’t think you have pain. Instead, your surgeon doesn’t think surgery will help. A qualified spine surgeon will let you know what type of treatment is best.

Is ACDF surgery considered a major surgery?

Yes, ACDF is a major surgery. Most people will go home the next day and will be off all pain medications within two to three weeks. While there are possible risks and complications, it’s a safe procedure that offers a high likelihood of relieving symptoms.

How common is ACDF surgery?

ACDF surgery is a common spine procedure. Approximately 132,000 people in the United States get this surgery each year.

How should I prepare for ACDF surgery?

Before ACDF surgery, you’ll meet with your surgical team. During the initial visit, your surgeon will perform a physical exam, and learn more about your general health and what medications or supplements you currently take.

They’ll order imaging tests, like an X-ray and MRI, if you haven’t done those already. This will help them better understand what causes your symptoms and make a plan to address them.

Your surgeon will give you specific instructions to follow before surgery. These instructions may include:

• Getting any additional tests like an electrocardiogram.
• Seeing your primary care physician or cardiologist in some cases.
• Cutting back on or stopping the use of tobacco products and stopping the use of marijuana and other substances.
• Avoiding drinking alcoholic beverages before the day of your surgery.
• Not taking blood thinners before the surgery. Don’t stop taking a medication unless your surgeon approves it.
• Making sure someone can drive you home after the surgery.

What happens during ACDF surgery?

On the day of your surgery, an anesthesiologist will give you anesthesia to put you completely to sleep so you won’t feel any pain.

Once you’re asleep, your surgeon will make a 1- to 2-inch incision (cut) in the front of your neck, usually horizontally, on one side. Your breathing tube (trachea) and swallowing tube (esophagus) will then be moved to the side.

Next, your surgeon will remove the affected disk and any associated bone spurs. In some cases, your surgeon will remove the entire front of the vertebra.

After your surgeon removes the disk and bone spurs, they’ll begin spinal fusion. Two or more of your vertebrae will turn into one bone. This occurs over time as the bones fuse or “knit” (like a broken arm would).

In the gap where the removed disk or disks were, your surgeon will place a piece of bone or a hollow metal ring filled with crushed bone. In most cases, this will be bone from a bone bank (a donor).

After the bone is in place, in most cases, your surgeon will place a metal plate and screws in the front of your spine to hold your bones in place while they fuse together.

Last, your surgeon will close up the incision site after moving everything back into place.

How long does ACDF surgery take?

ACDF surgery can take one to two hours in most cases. However, it may take longer for you to go to sleep and wake up, which can differ from the estimated surgery time.

What happens after ACDF surgery?

After ACDF surgery, you’ll move to an area of the hospital where your care team will monitor your vital signs as you wake up. Your healthcare provider will let you know when you’re able to go home. You should have someone available to drive you home after your surgery. You may need to stay overnight in the hospital, too.

Your surgeon will give you instructions to follow after surgery to help your body heal. This may include:

• Taking medications to alleviate pain.
• Resting and limiting physical activity (like doing aerobic exercises and lifting heavy objects).
• Wearing a neck brace and limiting neck movement in some cases.
• Changing your wound dressing over the incision site or leaving it open to air.
• Participating in physical therapy.

What are the benefits of ACDF surgery?

The main benefit of ACDF surgery is relief from pain or other symptoms that affect your quality of life. Many people report that they took fewer pain medications or eliminated the use of pain medications after surgery.

What is the success rate of ACDF surgery?

The success rate of ACDF surgery is 85% to 95%. If your goal is to significantly reduce pain and get back to your regular activities, there’s a good chance you’ll meet that goal after surgery.

What are the complications of ACDF surgery?

All types of surgery, including ACDF surgery, come with possible side effects. Your surgical team will take steps to prevent these so you can heal. Complications of ACDF surgery include:

• Difficulty swallowing.
• Bleeding.
• Infection.
• Blood clots.
• Reaction to anesthesia.
• Nerve damage (arm weakness, change in voice or difficulty holding your eyelid up).
• No symptom relief.
• Possibly needing another, future surgery.

Talk to your healthcare provider before surgery to learn more about the possible complications of ACDF so you can make an informed decision about your health.

Will I have permanent restrictions after ACDF surgery?

The fusion part of ACDF surgery limits your flexibility between the affected bones in your neck, but only between the vertebrae that fused. In most cases, those vertebrae were not very flexible before the surgery. Many people don’t notice a change in their flexibility after surgery.

How long does ACDF surgery last?

ACDF surgery is permanent. While rare, you may need additional surgeries to treat arthritis or weakening vertebrae near the initial surgical site (adjacent-level degeneration). Many studies report that ACDF surgery results last for more than 10 years before possibly needing additional surgeries.

What is the recovery time for ACDF surgery?

It could take between six months to a year for the fused bone to solidify in your neck after ACDF surgery.

During your recovery, your surgeon will give you specific instructions on how to take care of yourself and what activities are safe to do. You should be able to walk and sit up shortly after surgery. You can participate in light daily activities but avoid anything strenuous for at least six weeks. Anything involving contact sports, motorcycles, horseback riding or climbing should be avoided completely for at least three months, if not more.

Depending on what you do for a living, you may return to work in three to six weeks after surgery, with your healthcare provider’s approval. After three to four months, you should be able to go back to your regular activities fully.

Your surgeon may recommend physical therapy to strengthen the muscles in your neck. This usually happens four to six weeks after surgery. Your physical therapist will help you perform exercises so you can use your body to its full potential.

If you have questions about how your body heals or notice anything unusual like swelling, pain or skin color changes, let your healthcare provider know.

How painful is recovery after ACDF surgery?

You may experience some pain and soreness following ACDF surgery. During recovery, your healthcare provider will give you medications to manage pain and discomfort. Avoid putting too much stress on your body while you recover, which can affect how well your body heals. You should notice less pain than you had before the surgery shortly after it. If you have severe pain and swelling that won’t go away, contact your provider.

Can I live a normal life after ACDF surgery?

After you’ve fully recovered from ACDF surgery, you can return to your regular activities. You may notice that your neck isn’t as flexible when you bend it, but you’ll have significantly less pain after the procedure. When you follow the after-surgery care instructions that your surgeon provided, you should be able to get back to the activities you enjoy within a few months.

When should I call my healthcare provider?

Contact your provider if you experience the following after ACDF surgery:

• Continuous bleeding from the incision site.
• Yellow or green drainage from the incision.
• Severe pain.
• Fever.
• Worsening or persistent difficulty swallowing or eating.
• New weakness or numbness.