What is Anterior Cervical Discectomy and Fusion (ACDF)?

Anterior Cervical Discectomy and Fusion (ACDF) is a classic and very reliable surgery that treats pinched nerves (cervical radiculopathy) or a compressed spinal cord (cervical myelopathy). This surgery is a gold standard operation and was first described by Smith and Robinson in 1958. This is the original minimally invasive spine surgery as the surgery is performed in the plane BETWEEN structures in the neck and involves minimal muscle dissection.

Cervical radiculopathy is most commonly caused by a pinched nerve in the neck. Typically a disc herniation or bone spur will push into a nerve, producing symptoms including pain, numbness and tingling shooting into the neck, shoulder, arms and hand. In severe cases patients may experience arm weakness as well. Although the problem is in the neck, the patient will experience symptoms in the shoulder or arms through a phenomenon called referred pain. This pain is usually worse with looking upward (neck extension) or overhead activites and can often awaken patients from sleep.

Cervical myelopathy is commonly caused by spinal cord compression, usually due to a disc herniation or overgrowth of bone spurs or supporting ligaments in the neck. The most common symptoms of cervical myelopathy include worsening balance when walking and hand dysfunction, specifically worsening handwriting or dexterity with fine motor tasks.

ACDF is an excellent, minimally invasive treatment for both cervical radiculopathy and cervical myelopathy. In ACDF, Dr. NaPier will make a small incision hidden in the crease of your neck and gently dissect to the front of the spine. The worn or degenerated disc will be carefully removed. Using an operative microscope and microsurgical tools, disc herniation and bone spurs will be carefully removed, taking pressure off of the spinal cord and nerve roots. In most instances, this surgery is performed as an outpatient, meaning that you will go home the same day and spend the night in your own bed.

Here is a case example of a patient with bone on bone arthritis, disc collapse and pinched nerve and spinal cord.

Lateral xray demonstrating a collapsed degenerated disc (RED) with bone on bone arthritis and bone spurs compressing nerve roots and the spinal cord.  A healthy disc (GREEN) is outlined for comparison.

MRI demonstrating a healthy level with open nerve tunnels (GREEN).

MRI demonstrating degenerated level with spinal cord and nerve root compression (RED).

Xray after surgery demonstrating removal of bone spurs and placement of ACDF fusion cage.  The bone spurs have been removed (GREEN), the alignment and disc height have been restored, and the body is forming a fusion or bridge of bone THROUGH the fusion cage (BLUE).  This patient experienced immediate, significant relieve of her neck pain and nerve pain symptoms.  Individual results may vary.  This blog is published for general educational purposes only and is not intended as medical advice.