Anterior Cervical Discectomy And Fusion(ACDF) is a surgical procedure in which a spinal disc is completely removed (discectomy), followed by fusion of the two vertebrae within which the disc was present. It is done under the following conditions:
- Herniated disc: Accidents, sudden jerks to the neck during extreme movements, and lifting of heavy objects may cause a spinal disc to bulge out (herniation) of its place, compressing the spinal cord. In some cases, the disc may completely displace from its position, detach from its parent disc and lie within the spinal canal called extrusion.
- Disc degeneration: Degeneration or wear and tear of the spinal disc occurs in elderly individuals and long-standing cases of neck and nerve pain.
- Nerve pain: Nerves around the cervical spine (neck) may get compressed due to a herniating disc. This causes intense pain, tingling, and numbness in the arm and sometimes up to the fingers.
An ACDF may be done when other treatment options fail to relieve the patient's symptoms.
Anterior Cervical Discectomy And Fusion
Cervical spine (neck)
An incision or cut is made in the front of the neck(anterior) on the throat. The structures around the throat, including our vocal cords, oesophagus, and muscles, are pushed aside with instruments. The damaged disc is completely removed from its position to create a void between the two vertebrae.. The void space between the two vertebrae is filled with a bone cage(titanium)..
A screw fixation system is applied to completely seal the union between the vertebrae and bone graft. The tissues around the throat that were pushed aside are realigned, and the overlying skin is stitched together. A bandage is applied to protect the operated site and incision.
- Fitness tests are conducted to assess the patient's capability to withstand the surgery and anaesthesia. Tests include blood tests to study blood parameters such as haemoglobin and cell count, a cervical spine X-ray, and an MRI to understand the/ ct scan extent of disc damage and status of vertebrae. An ECG is done to confirm a healthy heart status and detect abnormalities. A chest x-ray is also done to assess the lungs.
- You will be asked to get admitted one day before surgery. In this phase, you will be monitored for vital signs like heart rate, pulse, temperature, and urine output status.
- 6-hour overnight fasting is required before the surgery. One can consume sufficient food and water before the fasting or may be administered saline in case of emergencies.
- You will be prepped for surgery by nurses and positioned on the operation table. An anesthesiologist will administer general or whole body anaesthesia.
Surgical invasive procedure
You will be asked to follow up at the end of 2 days for stitch removal and dressing. A regular follow-up routine will be set by your operating surgeon. Follow-up will be advised at the end of 4 weeks, 12 weeks, and quarterly thereafter for 1 year.
During these follow-up visits with your doctor, you will be assessed for incision healing and the position of the neck in lying down, sitting, and standing positions. Some balance and walking tests may be conducted to evaluate your ability to walk and maintain balance in every situation.
Another critical aspect of the follow-up routine is monitoring heart, lung, spinal cord, and brain function due to the risk of complications in these vital organs.
One is advised to start rehabilitation and physical therapy sessions to strengthen the muscles. Rehabilitation includes preparing to move out into the community, driving your car or bike, and carrying out everyday activities like bathing, dressing, grooming, toilet activities, etc.
As per the operating surgeon’s discretion, you can start driving by the end of the 4th week. Lifting heavy objects is prohibited for 3 months.