Anterior cervical Discectomy and Fusion

Anterior cervical discectomy and fusion, ACDF for short, is a surgical procedure that relieves pressure on nerve roots and/or the spinal cord by a herniated disc or bone spurs in the neck.

An ACDF is a surgical procedure used to treat problems in the cervical spine, such as herniated discs or spinal stenosis. The surgeon accesses the spine through a small incision in the front of the neck. The surgery involves removing a damaged or herniated disc from the front of the neck and then fusing the adjacent vertabrae together with a graft and often a plate with screws to stabilize the spine and relieve pressure on nerve roots and/or the spinal cord. This procedure is typically performed to alleviate pain, numbness, or weakness in the neck and arms.

If an ACDF has been recommended, you likely have a herniated disc and/or bone spurs causing compression on nerve roots and/or the spinal cord, which can cause:

• Pain in the neck and/or arms
• Numbness or weakness in the arms, forearms, or fingers
• Lack of coordination

An ACDF is typically recommended only after non-surgical treatment methods fail. Your surgeon will take a number of factors into consideration - including the condition being treated, your age, health, lifestyle, and activity level - to create an individualized treatment plan for you. Please discuss this treatment option thoroughly with your spine surgeon.

Here is a step-by-step overview of how an ACDF is performed:

1. Preparation: You will be given anesthesia to keep you asleep and pain-free during the surgery.
2. Incision: The surgeon makes a small incision in the front of your neck. This approach allows them to reach the cervical spine without moving the spinal cord or nerves.
3. Removal of the Disc: The surgeon carefully moves aside the muscles and other tissues to access the damaged disc. They then remove the problematic disc and any bone spurs that are pressing on your spinal cord or nerves.
4. Spinal Fusion: After removing the disc, a bone graft or synthetic material is placed between the adjacent vertebrae. This graft will help the bones fuse together as they heal.
5. Stabilization: In some cases the surgeon may use a metal plate and screws to stabilize the spine and ensure the vertebrae stay in place while they fuse
6. Closing the Incision: The surgeon closes the incision with stitches under the skin and applies a bandage.
7. Recovery: You will be monitored in the recovery room. You may be allowed to go home the day of your surgery or you may have to stay in the hospital for a short period. You will receive instruction for managing pain, wound care, and physical activity during your recovery.

The goal of the procedure is to relieve pain and restore function by removing the source of nerve compression and stabilizing the spine.

Your surgeon will have a specific recovery plan to help you return to your normal activity level as soon as possible after your cervical fusion. You may be allowed to go home the day of your surgery or you may have to stay in the hospital for a short period. You will typically be up and walking the day of your surgery. You typically return to work in 3-6 weeks, but some may return as early as one week after surgery, depending on how well your body is healing and the type of work/activity you do.

Work closely with your spine surgeon to determine the appropriate recovery for you.

While ACDF is generally safe, there are potential risks and complications to be aware of:

1. Infection: There is a risk of infection at the incision site or in the deeper tissues.
2. Bleeding: Some bleeding can occur during or after the surgery, though it is typically controlled.
3. Nerve Injury: There is a small risk of damage to the nerves near the spine, which might cause weakness, numbness, or pain.
4. Spinal Cord Injury: Although rare, there is a risk of injury to the spinal cord, which could lead to serious complications.
5. Nonunion or Malunion: Sometimes, the vertebrae may not fuse as expected, or the fusion might not occur correctly, leading to persistent pain or instability.
6. Hardware Problems: If metal plates or screws are used, they could become loose or cause discomfort.
7. Swallowing Difficulty: Some patients experience temporary difficulty swallowing due to swelling or irritation from the surgery.
8. Persistent Pain: There is a possibility that you might still have some pain or discomfort even after the procedure.
9. Problems with anesthesia: Your anesthesiologist will talk to you about these potential risks.

It's important to discuss these risks with your surgeon, who can provide more information based on your specific situation and help you understand how they plan to minimize these risks.

Your incision is closed with sutures (also called "stitches") underneath your skin. These are absorbed by your body over time. The outside of your skin is closed with a skin glue.

• Skin glue appears white, dry, and crumbly. Sometimes it is brown and crumbly.  
• The skin glue will gently break down and crumble off your skin, leaving it healed underneath.
• It is normal to have a small amount of brown or reddish colored ooze for a few days after surgery.
• Cover the incision with gauze and tape for 1 week after surgery 
• After 1 week, you may remove the dressing and leave the incision uncovered.  
• Avoid getting skin glue wet for 7 days (unless instructed otherwise by your surgeon).
• Do not apply ointments or creams to the incision.
• Do not submerge your neck in water for 6 weeks.

**Do not scrub off the skin glue 

• Pain with swallowing is normal in anterior cervical fusion recovery.  This occurs because your trachea (windpipe) and your esophagus (tube connecting your mouth to your stomach) must be gently held aside during surgery.  This should improve over the next few weeks.  If you are having difficulty with swallowing, eat a soft diet.  Avoid foods such as meats and breads as these often may feel “stuck” when swallowing.  
• If you cannot swallow food or liquids you should call our office.
• It is normal to have a sore throat after endotracheal intubation, and this will improve over the week after surgery.
• It is normal to have pain in your neck or between your shoulder blades.  There are many muscle groups in the back of the neck that are stretching to accommodate the new disk space that was created.  This will improve over the next few weeks 

• You will be given prescriptions for a pain medication.
• Use medication as directed.
• Do not drink alcohol if you are taking pain medication.
• If you feel that your pain is well tolerated, you may begin to wean yourself off of your pain medication as soon as you would like.
• If your pain requires narcotic pain medication >4 weeks after surgery, you will be referred to a pain management specialist to help wean you off these medications.
• Pain medication can cause constipation. Take the stool softener daily and use the laxative as needed. If you still have constipation after using these medicines, you may use an over-the-counter suppository or enema.  

• NO Aspirin, Advil, Aleve, Motrin, Naprosyn, Ibuprofen, Naproxen, Mobic, Meloxicam, Celebrex, or any other anti-inflammatory medication.  These medicines may impair fusion.  We discourage use of these medications for the first 3-6 months after a fusion surgery.
• NO blood thinners such as Aspirin, Coumadin, Warfarin, Xarelto, Plavix, etc.  for 5-7 days after your surgery.  We will tell you when you may resume your blood thinners.  

• When you are at home, walk between 30-60 minutes a day, but not all at the same time. Divide your walks into smaller intervals of 10-15 minutes at a time.
• Try to not sit for more than 30 minutes at a time.  Sitting for long periods of time can cause more discomfort.
• Use your common sense, if your body says that it is tired, listen to it.

• Activities including working above your shoulders and lifting >10 pounds are restricted during your recovery period, which is about 6 weeks.
• This means NO household chores such as vacuuming and laundry, hobbies such as golfing, and yard work/gardening.
• If you have young children or grandchildren, do NOT pick them up.  
• You may drive as long as you are not taking narcotic pain medication. 
• If you are unable to work due to these restrictions, please let us know if we need to complete any paperwork for your employer. 

• Soft foods for the first week is recommended. These include soups, puddings, oatmeal, liquids, mashed potatoes, vegetables and fruits, etc. Avoid breads and meats such as steak as these may cause discomfort.  
• You may advance your diet to more solid food when you feel comfortable swallowing

• Do not use any sort of nicotine during your recovery. This includes smoking, smokeless tobacco, vaping and nicotine patches.
• Nicotine constricts your blood vessels which carry oxygen and nutrients to your healing bone and muscles. 
• It also slows down the bone healing process and may possibly lead to failure of fusion. Failure of fusion may necessitate additional surgery.
• If you would like help in cessation, please let us know.

• If you go home the same day of surgery, your surgeon will see you in clinic the day after your surgery.
• A follow-up visit will be scheduled about 4 weeks after your surgery.
• It is important to keep your appointments after a fusion procedure, as your surgeon typically performs x-rays over the first year after your surgery to ensure it is healing correctly.
• If you need this appointment changed, please call our office 

• Swelling of the neck with difficulty breathing

• Swelling of the neck with difficulty swallowing
• Fever > 101 degrees 
• Constipation that is not relieved by stool medications 
• Redness, warmth, or significant drainage from your incision
• Shortness of breath or Chest Pain 
• Pain, swelling, or redness in your calves
• Unexplained incontinence or accidents involving your bladder or bowel, or if you are unable to urinate
• Worsening neck or arm pain
• Inability to tolerate a diet 

If you are experiencing any problems or have any questions, please contact our office at (573) 635-8000

After surgery patients should avoid bending, lifting, and twisting. It is helpful to place items you use daily on the countertops or shelves where you can easily reach them. Keep toiletry items near the sink. Place dishes on the kitchen counter.

If you live alone, it is a good idea to have a friend or family member stay with you for the first few days after surgery. You may need help with errands or getting around the house. If you require more extensive help after surgery, home health services may be provided.   

It can be difficult to prepare healthy meals the first few days you are recovering from back surgery. Prepare your meals ahead of time that you can keep in your freezer. You should also stock your refrigerator and pantry with healthy snacks.

Slip -on shoes and grabbers can be very helpful after surgery. If you are doing physical therapy exercises or walking for longer periods of time, you may want to have someone help you lace up your shoes instead of wearing slip-on shoes.  Grabbers are hand-held devices that are about 2-3 feet long and have a grabber on the end to pick up small items.  They can be purchased at department stores and pharmacies.   

Patients are encouraged to get up and walk around after surgery.  You will want to make sure to avoid any slipping hazards in your walking path. Before surgery, make sure that the areas where you will be walking are clear of tripping hazards. Cords should be secured and out of the way. Rugs should be removed or taped down. A shower mat can help avoid slipping in the shower.   

When lying on your back, a pillow placed under the knees can help to take pressure off your lower back. If you prefer to lay on your side, you can place a pillow between your knees. Reclining chairs and donut pillows can sometimes help to increase a patient’s comfort while sitting.

Taking time to prepare yourself and your home before surgery will help to ease your mind to know that everything is in place for you when you return home from surgery.