Anterior Cervical Discectomy and Fusion

ACDF-Anterior cervical discectomy and fusion is a surgical procedure performed through the front of the neck (anterior) to remove one or more degenerative or herniated disc in the cervical (neck) spine. Removing the disc alleviates the pressure caused by the bulging disc on the surrounding nerve roots and spinal cord. Usually a discectomy is combined with a fusion of the two vertebrae that are separated by the disc.

Because the procedure decompresses the nerves roots, it also sometimes referred to as a cervical decompression. If no graft is done, the procedure is simply a cervical discectomy. A cervical discectomy without a fusion may be suggested for younger patients between 20 and 45 years old who have symptoms due to a herniated disc.

A surgeon will get a diagnostic test done to confirm the herniated disc (MRI, CT, myelogram). ACDF is generally recommended after other non-surgical treatments have failed to alleviate symptoms.

What is a Herniated Disc?
Discectomy is used to alleviate symptoms of a herniated disc. A disc herniation happens when the nucleus inside the center of the disc pushes through the annulus, the ligaments surrounding the nucleus. The herniated disc material may push outward, causing pain. Numbness or weakness in the arm occurs when the nucleus pushes on the spinal nerve root. Of greater concern is a condition in which the nucleus herniates straight backward into the spinal cord, called a central herniation. Discectomy relieves pressure on the ligaments, nerves, or spinal cord.

Symptoms

  • Pain in arms and neck (arm pain generally worse than neck pain)
  • Significant weakness in hand or arm

How does ACDF work?

A cervical disc herniation can be removed through an anterior approach (through the front of the neck). The disc material pressing on the spinal nerve or spinal cord is completely removed. The bone channel through which the spinal nerve runs is then enlarged giving the nerve more room to exit the spinal canal.

To increase stability of the spinal column, the open space left by the discectomy is often filled with bone graft taken from the pelvis or cadaveric bone. The slow process of the bone graft joining the vertebrae together is called “fusion”. Sometimes a titanium plate is screwed on the vertebrae or screws are used between the vertebrae to increase stability during fusion, especially when there is more than one disc involved.