Long Island Neurosurgical & Spinal Associates (LINSA)
Spine Surgery 

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 Anterior Cervical Discectomy & Fusion (ACDF)  

A procedure where the cervical spine is approached from the front. It is used when the pathology (herniated discs, bone spurs, tumors) is in front of the spinal cord and cannot be accessed directly from behind (the spinal cord is in the way).

After a small skin incision off to the side (right or left), the loose intermuscular planes are separated by gentle dissection, staying between the midline structures (larynx and esophagus) and the carotid artery laterally. A special retractor is placed to provide a small channel to the front of the cervical spine. This allows for the removal of the affected discs and their bone spurs, or other pathology. If necessary, whole vertebral bodies can be removed (corpectomy). In this fashion the nerves and spinal cord can be decompressed. The removed discs are replaced by inserting a "spacer" between the vertebrae to prevent collapse of the disc space. Many different "spacers" are available, from patient's own bone (autologous pelvic bone), pre-shaped bone bank bone (allograft), to special biomedical implants (cages, tantalum grafts, PEEK composite grafts).

These fusions are most commonly re-enforced by placing a small titanium plate across the vertebral levels with bone screws (anterior cervical plating) to hold the  vertebral bodies together until the bony fusion has occurred.  Many different systems are on the market. Once fusion has occurred, the plates could be removed if necessary, but they are usually left in place since they rarely cause problems. Despite a high eventual fusion rate, certain conditions increase the risk for "non-union" such as smoking and number of fused levels. This risk can be somewhat counteracted by applying an external Bone Growth Stimulator (Orthofix®) after the surgery. This is a device that surrounds the neck with an electro-magnetic field and is worn as a collar around the neck for 4 hours per day. If despite these measures a "non-union" occurs it may lead to persistent instability and result in intractable neck pain. Sometimes this necessitates a "re-do" fusion.

The procedure is usually well tolerated and most patients can go home after an overnight stay. A soft cervical collar is usually prescribed in the beginning. The most common post-operative complaints are throat discomfort, swallowing difficulties and a new pain between the shoulder blades. These complaints are "normal" and gradually clear in most cases. Although complications are rare, they do occur and your surgeon will discuss these with you in full detail.

ACDF is one of the most common procedures done by spine surgeons and has a well established track record. It is the "gold standard" in the treatment of disc disease of the cervical spine, by which all other newer approaches are being judged. This includes the new artificial disc replacement surgery.