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Anterior Cervical Discectomy and Fusion

Anterior cervical discectomy and fusion (ACDF) is a procedure used to treat neck problems such as cervical radiculopathy, disc herniations, fractures, and spinal instability. In this procedure, the surgeon enters the neck from the front (the anterior region) and removes a spinal disc (discectomy). The vertebrae above and below the disc are then held in place with bone graft and sometimes metal hardware. The goal is to help the bones to grow together into one solid bone. This is known as fusion. The medical term for fusion is arthrodesis.

Operating on the back of the neck is more commonly used for neck fractures. That procedure is called posterior cervical fusion.

What parts of the neck are involved?

Surgeons perform this surgery through the front part of the neck. Key structures include the ligaments and bones, intervertebral discs, the spinal cord and spinal nerves, and the neural foramina.

In most cases, ACDF is used to stop symptoms from cervical disc disease. Discs start to degenerate as a natural part of aging and also from stress and strain in the structures of the neck. Over time, the disc begins to collapse, and the space decreases between the vertebrae.

When this happens, the openings around the spinal nerves (the neural foramina) narrow and may begin to put pressure on the nerves. The long ligaments in the spine slacken. They may even buckle and put pressure on the spinal cord. The outer rings of the disc, the annulus, weaken and develop small cracks. The nucleus in the center of the disc may press on the weakened annulus and actually squeeze out of the annulus. This is called a herniated disc. The herniated disc may press on ligaments, nerves, or even the spinal cord. Fragments of the disc that press against the outer annulus, spinal nerves, or spinal cord can be a source of pain, numbness, and weakness. Pressure on the spinal cord, called myelopathy, can also produce problems with the bowels and bladder, changes in the way you walk, and trouble with fine motor skills in the hands.

Discectomy is the removal of the disc (and any fragments) between the vertebrae that are to be fused. When symptoms are coming from the disc, it is hoped that this stops the symptoms.

Once the disc is removed, surgeons spread the bones of the spine apart slightly (distraction) to make room for the bone graft. This is bone material that can be taken from the top of the pelvis bone (autograft) or from a natural substitute (allograft). The bone graft separates and holds the vertebrae apart. Enlarging the space between the vertebrae widens the opening of the neural foramina, taking pressure off the spinal nerves that pass through them. Also, the ligaments inside the spinal canal are pulled taut so they don't buckle into the spinal canal.

No movement occurs between the bones that are fused together. By holding the sore part of the neck steady, the fusion helps relieve pain. And it prevents additional wear and tear on the structures inside the section that was fused. This keeps bone spurs from forming, and it has been shown that fusion causes existing bone spurs to shrink. By fusing the bones together, surgeons hope that patients won't have future pain and problems from cervical disc disease.

How will I prepare for surgery?

The decision to proceed with surgery must be made jointly by you and your surgeon. You should understand as much about the procedure as possible. If you have concerns or questions, you should talk to your surgeon.

Once you decide on surgery, your surgeon may suggest a complete physical examination by your regular doctor. This exam helps ensure that you are in the best possible condition to undergo the operation.

On the day of your surgery, you will probably be admitted to the hospital early in the morning. You shouldn't eat or drink anything after midnight the night before.

What happens after surgery?

After ACDF, patients usually wear a special neck brace for several months. These neck braces are often bulky and restrictive. However, the bone graft needs time to heal in order for the fusion to succeed. This requires the neck to be held still.

Recently, surgeons have begun using metal hardware, called instrumentation, to lock the bones in place. This hardware includes metal plates and screws that are fastened to the neck bones. They hold the neck bones still so the graft can heal, replacing the need for a rigid neck brace.

Patients may stay in the hospital for one to two days after surgery. When the surgery is done on an outpatient basis, patients may even go home the same day of surgery. Patients can get out of bed as soon as they feel up to it. They are watched carefully when they begin eating to make sure they don't have problems swallowing. They usually drink liquids at first, and if they are not having problems, they can start eating solid food.

Patients are able to return home when their medical condition is stable. However, they are usually required to keep their activities to a minimum in order to give the graft time to heal.

What should I expect as I recover?

Rehabilitation after ACDF can be a slow process. You will need to attend Physical Therapy sessions for two to three months, and you should expect full recovery to take up to eight months.

At first, treatments are used to help control pain and inflammation. Ice and electrical stimulation treatments are commonly used to help with these goals. A Physical Therapist may also use massage and other hands-on treatments to ease muscle spasm and pain.

A physical therapist will then slowly add active treatments. These include exercises for improving heart and lung function. Walking and stationary cycling are ideal cardiovascular exercises. Physical Therapists
also teach specific exercises to help tone and control the muscles that stabilize the neck and upper back.

A Physical Therapist also works with you on how to move and do activities. This form of treatment, called body mechanics, is used to help you develop new movement habits. This training helps you keep your neck in safe positions as you go about your work and daily activities. At first, this may be as simple as helping you learn how to move safely and easily in and out of bed, how to get dressed and undressed, and how to do some of your routine activities. We will teach you how to keep your neck safe while you lift and carry items and as you begin to do other heavier activities.

As your condition improves, a Physical Therapist will begin tailoring your program to help prepare you to go back to work. Some patients are not able to go back to a previous job that requires heavy and strenuous tasks. A Physical Therapist may suggest changes in job tasks that enable you to go back to your previous job or to do alternate forms of work. You'll learn to do these tasks in ways that keep your neck safe and free of extra strain.

Before your Physical Therapy sessions end, a Physical Therapist will teach you ways to avoid future problems.

Article Source: MMG, LLC