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Cervical Anterior Discectomy and Fusion

Anterior Cervical Discectomy and Fusion (ACDF)

ACDF is the most commonly performed procedure to treat cervical radiculopathy. The procedure involves removing the problematic disc or bone spurs and then stabilizing the spine through spinal fusion.

The objectives of the ACDF are:

Restore spine alignment

Maintain the space available for the nerve roots to leave the spine

Limit movement along the degenerated portion of the spine

Procedure. The "anterior" approach means the doctor will approach your neck from the front. It will work with a 1 to 2 inch incision along the neck crease. The exact location and length of your incision may vary depending on your particular situation.

During the procedure, your doctor will remove the problematic disc and, if necessary, additional bone spurs. Disk space is restored to the height before the disk wore out. This makes more room for the nerves to leave the spine and aids in decompression.

Spinal fusion. After the disc space is cleared, your doctor will use spinal fusion to stabilize your spine. Spinal fusion is actually a "welding" process. The basic idea is to fuse the vertebrae into one solid bone. The fusion eliminates movement between the degenerated vertebrae and takes away some of the spinal flexibility. The theory is that if painful spinal sections don't move, they shouldn't hurt.

All spinal fusions use a type of bone material called a bone graft to help support the fusion. Small pieces of bone are placed in the space left where the disc was removed. Sometimes larger, solid pieces are used to provide immediate structural support to the vertebrae.

In some cases, the doctor may place a metal, plastic, or bone spacer between two adjacent vertebrae. This spacer or "cage" often contains bone graft material to allow a spinal fusion between the two vertebrae to occur.

After the bone graft or cage is placed, your doctor will use metal screws and plates to increase the rate of fusion and further stabilize the spine.

X-ray showing anterior cervical discectomy and spinal fusion

Lateral (left) and anterior (right) anterior cervical discectomy and fusion. Plates and screws are used to provide stability and increase the fusion rate.

Bone graft sources. The bone graft will come from either your own bone (autograft) or a donor (allograft). If autograft is used, bone is usually taken from your hip area. Removing a bone graft from your hip requires an additional incision during your surgery. It prolongs the operation time and may cause increased post-operative pain.

If only a small amount of bone is needed, your doctor may use bone spurs from your neck as autografts. Bone is essentially recycled; it is moved from an area that is no longer needed to the area that the surgeon wants to fuse. Your doctor will talk to you about the advantages and disadvantages of using an autograft instead of an allograft, as well as using a traditional bone graft versus a cage.

Hip anatomy showing the iliac crest of the hip

Most autografts are taken from the iliac crest of the hip.

Artificial Disk Replacement (ADR)

This procedure involves removing the degenerated disc and replacing it with artificial parts, as with a hip or knee replacement. The purpose of a disc replacement is to allow the spinal segment to retain some flexibility and move more normally.

Similar to ACDF, your doctor will use an "anterior" approach to surgery and make a 1 to 2 inch incision along the neck crease. The exact location and length of your incision may vary depending on your particular situation.

During the surgery, your doctor will remove your problematic disc and then place an artificial disc implant in the disc space. The implant is made entirely of metal or metal and plastic. It is designed to maintain movement between the vertebrae after the degenerated disc is removed. The implant can help restore height between the vertebrae and widen the passageway for the nerve roots to exit the spinal canal.

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