Anterior Cervical Discectomy and Fusion (ACDF)

This procedure is a type of minimally invasive neck surgery performed by Dr. Michael Casnellie and Dr. David McConda. The primary goal of an anterior cervical fusion (ACDF) surgery is to relieve pressure on either the nerve roots or spinal cord and/or treat an unhealthy disc in the cervical spine. An anterior cervical discectomy is often performed along with procedures called fusion and fixation to ensure spinal stability. A fusion is the implantation of a bone graft that will fuse (grow together) with vertebrae (bones of the spine) in the area. A fixation is the implantation of screws, rods or plates. A fixation is a common way to hold the bones in place while they fuse. An Anterior Cervical Discectomy and Fusion is often abbreviated ACDF.

ACDF Brochure

Anterior cervical discectomy (ACDF) is performed for patients who have experienced changes such as degeneration and bone spurs (growth of bony projections) in the discs of the cervical spine, and for those with herniated discs. These conditions can affect the amount of space available for the spinal cord and nerves. As a result, the spinal cord and nerves can become compressed (pinched), and even injured. Between each bone of the spinal column is a cushion called an invertebral disc.

These discs prevent the bones from grinding against one another and act as shock absorbers during falls, exercise, and daily activities. Sometimes, these discs become damaged, causing pain that can range from moderate to intense. An ACDF procedure may be carried out on any of the discs in between the seven cervical bones.

In an ACDF, unhealthy disc is removed (discectomy) and replaced with an interbody fusion implant. A plate, spacer, and screws construct, or an integrated plate-spacer with fixation (i.e. screws, or other anchors), may be used to hold the vertebrae in place while fusion (joining of two bones) occurs.

It is at this point during the procedure that the surgeon replaces the disc.

There are a few options for disc replacement:

Bone graft: A bone graft is when the surgeon attaches bone to the area to replace the disc. The bone may come from somewhere else in the person’s own body, or from a bone bank.
Bone graft substitute: Similar to a bone graft, this approach uses human-manufactured materials that contain shavings from the person’s bones.
Arthroplasty: This is when the surgeon replaces the disc with an artificial disc.

When conservative treatments fail, and a patient’s pain and symptoms are enough to interfere with daily life, a doctor will assess whether ACDF is likely to help with the pain. Patients tend to be good candidates for surgery if they:

have signs of disc damage on an imaging scan
have pain, weakness, or tingling in the hand or arm
have neck pain due to pinched spinal nerves
have tried other treatments but have not improved

Description of Procedure

At Aptiva Health, our Spine Team typically performs ACDF procedures in an outpatient setting, which means the individual returns home the same day as surgery. The operation takes place under general anesthesia so the person will be asleep.

A small horizontal incision (a surgical cut made in skin) is made in the anterior (front) of the neck to either the left or right of the center. The soft tissues of the neck are gently separated to allow access to the surgical site. Surgical instruments are used to remove the disc and decompress (relieve pressure on) the nerve structures.

To fill the vacant disc space and join the vertebrae together, an interbody fusion implant is used. If a combination of a spacer and a plate are used, the spacer is placed into the disc space with the plate placed on top of the spine for stability. Screws are then inserted through the plate into the upper and lower vertebrae.

Or, if an integrated plate-spacer implant is used, the implant is placed into the disc space and fixation hardware, screws in this example, are inserted to secure the implant in place. Over time, the vertebrae can grow together through fusion. This process varies between patients and can take anywhere from a few months up to a couple of years to completely fuse.

After the surgery, most patients will experience some pain that will effectively be managed with pain medication. Recovery from an ACDF takes several weeks, and most patients are prescribed a cervical collar to stabilize the neck after surgery. Most patients will follow up with the Aptiva Health Spine team 4 to 6 weeks following surgery for an assessment and should avoid any strenuous activity until cleared by the operating surgeon.

Find a complete list of our post-operative instructions for ACDF patients here.

Frequently Asked Questions

What Should I Expect from Surgery?

Treatment with an ACDF may help you return to normal activities. Patients may notice improvement of some or all symptoms, and pain from surgery may diminish between 2 to 4 weeks after surgery. However, recovery time varies between patients and is dependent upon on other factors such as comorbidities and levels involved in the cervical fusion. It is the surgeon’s goal for the patient to eventually return to his/her preoperative activities. A positive attitude, reasonable expectations and compliance with your doctor’s post-surgical instructions may all contribute to a satisfactory outcome.

What is post-surgical rehabilitation and recovery like?

Most people can begin driving just a few weeks after surgery. The majority of patients will need four to six weeks to complete the initial healing process following surgery, but recovery varies according to age, health, and other factors. After a follow-up appointment with the operating surgeon, patients will typically begin post-operative physical therapy. Post-operative physical therapy’s goal is to reduce pain and restore mobility in the neck.

An active lifestyle that includes plenty of exercise can aid recovery. However, people should get permission from the surgeon before they start exercising. Some individuals might need to avoid strenuous physical activity to prevent injuries to the neck.

Find our post-operative instructions here.

When Will I Be Able to Return to Work?

The amount of recovery time needed prior to returning to work will vary depending on the surgery, your job, and you as an individual. Please consult your surgeon for an individual recommendation.

How Long Will I Have Restricted Activities?

As with any surgery, the duration of time between procedure and return to normal activities is different for every patient. Your surgeon may provide a list of activities you should avoid during the first six weeks after surgery.