Anterior cervical decompression (discectomy) and fusion (ACDF) is a surgical procedure that is performed through the front of the neck in order to relieve pressure on the spinal cord and/or the nerves and stabilize the spine as well.
ACDF can be performed for a variety of reasons such as treating trauma, degenerative disorders, tumours or instability of the spine. However, this surgery is only recommended when extensive and conservative measures such as physical therapy, pain medication, nerve sheath injections, neck collars etc have either failed or the degree of spinal compression is severe.
A decompression or discectomy means cutting out the disc and it can be performed anywhere along the spine from the cervical (neck) to the back (lumbar). The surgeon accesses the damaged disc from the anterior (front) of the spine via the throat area. The bony vertebrae and the disc are exposed when the neck muscles, trachea and oesophagus are moved aside. It is easier to reach the disc when surgery is performed from the front of the neck as compared from the back (posterior) as it can be done without disturbing the strong neck muscles, spinal cord and spinal nerves. One disc (level) or more (multilevel) may be removed depending on what is being treated.
The disc removal usually leaves an empty space between the bony vertebrae. To fill the open disc space and prevent the vertebrae from collapsing and rubbing together, a spacer bone graft is inserted. The vertebrae and bone graft are fixed with screws and metal plates. The grafts tend to serve as a bridge between the two vertebrae creating a spinal fusion.
After the procedure, the body starts its natural healing process as new bone cells grow around the graft. About 3 to 6 months following the surgery, the bone graft usually joins the two vertebrae forming one solid piece of bone.
There are various sources of the bone grafts and they include:
- Autograft bone which comes from the patient
- Allograft bone which comes from a donor (cadaver)
- Bone graft substitute, which is usually man-made ceramic, plastic or bioresorbable compounds.
Following the fusion, the patient may experience some range of motion loss although this tends to vary according to the number of levels fused together. He or she may result in having similar or even better range of motion than you did prior to the surgery. He or she may however have limits in looking up and down as well as turning your head if two or more levels are fused.
As an alternative to fusion, there are motion-preserving artificial disc replacements. These are inserted into the damaged space so as to preserve motion as compared to fusion which eliminates motion. The specialist should be able to recommend which would be more appropriate for you, whether ACDF or artificial disc replacement.
Candidate for Discectomy
One may be a candidate for ACDF if he or she has:
- Diagnostic tests indicating that the patient has a degenerative or herniated disc
- Dull pain in the arm
- Significant weakness in the arm and hand
- Symptoms that have not improved with medication or physical therapy
This procedure is performed by an orthopaedic surgeon or a neurosurgeon.
Next Steps
At King’s College Hospital Dubai, we focus on offering an exemplary service, from initial consultation through to final diagnosis and treatment and beyond. Our multidisciplinary team of expert doctors, nurses, physio therapists are here to offer tailored management and treatment of your condition, and to answer any questions that you might have throughout your time with us. Whatever you need us for, we’re only a phone-call away.
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