Anterior Cervical Decompression with Fusion

Anterior cervical decompression with fusion, or ACDF, is a surgical procedure that combines partial or full removal of a damaged spinal disc in your neck with a follow-up stabilization procedure called spinal fusion. Your doctor may recommend ACDF if you’re one of the relatively few people who have long-term neck pain in the aftermath of a disc injury.

Anterior Cervical Decompression With Fusion Basics

Before performing the main portion of anterior cervical decompression with fusion, your surgeon will need to prepare material called a bone graft, which is used to fuse two of your neck vertebrae together toward the end of the procedure. Sometimes, this graft material comes from a section of your own hip bone, or from a bone bank that collects graft material from cadaver tissue donors. However, your surgeon may also choose to use an artificial graft called a cage, which can be made from ceramics, plastics or other manmade components and acts as a holder for a collection of bone shavings. A more modern option is an entire replacement disc made from artificial materials.

Anterior surgical procedures get their name because they’re performed front the front, or anterior side, of your body. In the case of anterior cervical decompression with fusion, your surgeon will begin the main part of the procedure by making a short incision to one side of the front of your neck, then carefully pulling aside your windpipe, esophagus, muscles and blood vessels until he exposes your spinal discs and vertebrae. Next, he will use a device called a spreader to hold two neighboring vertebrae in place while he pulls out the damaged disc that sits between them.

After checking to make sure he’s removed any disc fragments intruding upon your spinal cord or nearby nerves, your surgeon will place the graft material in the space formerly occupied by the disc. As your body heals, it will naturally fuse bone from the neighboring vertebrae to the bone graft and create a single, longer bony structure. In some cases, your surgeon will assist the fusion process by fixing the graft in place with metal plates or rods screwed into the vertebrae on either end of the surgical site.

Anterior Cervical Decompression With Fusion Uses

Anterior cervical decompression with fusion is commonly used to repair damage caused by a herniated spinal disc or by a disorder called degenerative disc disease, which can shrink the affected spinal disc and trigger any one of a number of structural problems. Still, doctors typically only recommend any form of surgery when these conditions last for at least six weeks after the start of nonsurgical treatment; cause significant pain in an arm as well as in the neck; and/or produce serious or progressive weakness in an arm or hand. Only 1 in 10 patients with cervical disc problems has symptoms that are severe enough and last long enough to warrant surgical consideration.

Anterior Cervical Decompression With Fusion Benefits

Roughly 93 percent of people who undergo ACDF without supporting plates or rods experience successful fusion of the targeted vertebrae. From a statistical point of view, almost all patients who undergo ACDF with supporting plates or rods experience successful spinal fusion. Roughly 90 to 100 percent of patients who undergo anterior cervical decompression with or without fusion experience substantial relief of their arm pain symptoms, while approximately 75 to 85 percent of this same patient group experiences substantial relief of their neck pain. Anterior cervical fusion with decompression typically provides the greatest benefits to patients with pain centered in their arms.

Anterior Cervical Decompression With Fusion Risks

Potential risks associated with performance of anterior cervical decompression with fusion include accidental injury to your windpipe or esophagus, speaking or swallowing problems related to damage in these structures, accidental injury to your spinal cord or a spinal nerve, uncontrolled bleeding, failure to relieve your symptoms, postsurgical infection and lack of adequate fusion in the grafted section of your neck. In general, you can reduce your risks for complications by working with a surgeon who has a good track record with the procedure. You can lower your specific risks for failed fusion by avoiding smoking during the months following your surgery.

 

References

Spine-Health: ACDF – Anterior Cervical Decompression and Fusion
Mayfield Clinic for Brain & Spine: Anterior Cervical Decompression & Fusion (ACDF)
University of Virginia School of Medicine: Anterior Cervical Decompression and Fusion