Anterior cervical discectomy and fusion (ACDF) is a surgical procedure to treat nerve root or spinal cord compression by decompressing the

spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone). The backbone encloses the central canal of the sp ...

and nerve roots of the cervical spine with a discectomy, followed by inter-vertebral fusion to stabilize the corresponding

vertebra The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristi ...

e. This procedure is used when other non-surgical treatments have failed.

Medical uses

ACDF is used to treat serious pain from a

nerve root A nerve root (Latin: ''radix nervi'') is the initial segment of a nerve leaving the central nervous system. Nerve roots can be classified as: *cranial nerves, Cranial nerve roots: the initial or proximal segment of one of the twelve pairs of crania ...

that has become inflamed. This can be caused by: 1. a herniated disc when other non-surgical treatments have failed. The

nucleus pulposus An intervertebral disc (or intervertebral fibrocartilage) lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint (a symphysis), to allow slight movement of the vertebrae, to act as a ligament to hold t ...

(the jelly-like center of the disc) of the

hernia A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Various types of hernias can occur, most commonly involving the abdomen, and specifically the groin. Groin her ...

ted disc bulges out through the

annulus Annulus (or anulus) or annular indicates a ring- or donut-shaped area or structure. It may refer to: Human anatomy * ''Anulus fibrosus disci intervertebralis'', spinal structure * Annulus of Zinn, a.k.a. annular tendon or ''anulus tendineus com ...

(surrounding wall) and presses on the nerve root next to it. 2. degenerative disc disease ( spondylosis). The disc consists of about 80% water. When one grows older, the disc starts to dry out and shrink, causing small tears in the annulus and inflammation of the nerve root.

Contraindications

Bone morphogenetic protein Bone morphogenetic proteins (BMPs) are a group of growth factors also known as cytokines and as metabologens. Originally discovered by their ability to induce the formation of bone and cartilage, BMPs are now considered to constitute a group of ...

(rhBMP) should not be routinely used in any type of anterior cervical spine fusion, such as with anterior cervical discectomy and fusion., which cites * * There are reports of this therapy causing swelling of

soft tissue Soft tissue is all the tissue in the body that is not hardened by the processes of ossification or calcification such as bones and teeth. Soft tissue connects, surrounds or supports internal organs and bones, and includes muscle, tendons, ...

which in turn can cause life-threatening complications due to

difficulty swallowing Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right. It may be a sensation that suggests difficulty in the passage of solids or liqui ...

and pressure on the

respiratory tract The respiratory tract is the subdivision of the respiratory system involved with the process of respiration in mammals. The respiratory tract is lined with respiratory epithelium as respiratory mucosa. Air is breathed in through the nose to ...

Technique

The

neurosurgeon Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peri ...

orthopedic surgeon Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...

enters the space between two discs through a small incision in front (= anterior) of and at the right or left side of the neck. The disc is completely removed, as well as arthritic bone spurs. The disc material, pressing on the spinal nerve or spinal cord, is then completely removed. The

intervertebral foramen The intervertebral foramen (also called neural foramen, and often abbreviated as IV foramen or IVF) is a foramen between two spinal vertebrae. Cervical, thoracic, and lumbar vertebrae all have intervertebral foramina. The foramina, or openi ...

, the bone channel through which the spinal nerve runs, is then enlarged with a drill giving the nerve more room to exit the spinal canal. To prevent the vertebrae from collapsing and to increase stability, the open space is often filled with a graft. That can be a

bone graft Bone grafting is a surgical procedure that replaces missing bone in order to repair bone fractures that are extremely complex, pose a significant health risk to the patient, or fail to heal properly. Some small or acute fractures can be cured wit ...

, taken from the

pelvis The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The ...

or cadaveric bone; or an artificial implant. The slow process of the bone graft joining the vertebrae together is called "fusion". Sometimes a

titanium Titanium is a chemical element with the symbol Ti and atomic number 22. Found in nature only as an oxide, it can be reduced to produce a lustrous transition metal with a silver color, low density, and high strength, resistant to corrosion i ...

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.

Recovery

The surgery requires a short stay in the clinic (1 to 3 days) and a gradual recovery between 1 and 6 weeks. However, the technology has advanced and it can be performed by 'Endoscopic Micro Discectomy" with the patient able to continue their normal life in two days. The patient may be advised to wear a neck brace or collar (for up to 8 weeks) that serves to ensure proper spinal alignment. Wearing the brace heightens one's awareness of posture and positioning and helps prevent movements (e.g., sudden and/or excessive bending or twisting of the neck) that may aggravate or slow down the healing process. It is especially advisable to wear a protective neck brace when traveling (e.g., by car), sleeping, showering, or any other activities in which the patient may not be able to be ensure proper spinal alignment. In addition, physical therapy and related healing modalities (e.g., massage, acupuncture) may be recommended in order to promote proper healing, as well as to strengthen the surrounding muscles that can take over the neck brace's 'job' of ensuring proper spinal alignment when the patient starts (around 4 to 6 weeks after surgery) to wean off the neck brace.

References

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External links

Anterior Cervical Discectomy
Neurosurgical procedures Orthopedic surgical procedures