What Is Anterior Cervical Discectomy and Fusion (ACDF) Surgery?
If you have neck pain or arm pain due to cervical radiculopathy, you may benefit from a surgical procedure called anterior cervical discectomy and fusion (ACDF). This surgery is performed to remove a damaged disc from your spine and relieve pressure off of spinal nerves. This can help improve neck pain or pain in your arm that is coming from your neck.
Purpose of ACDF Surgery
Many times, neck pain and cervical radiculopathy (arm pain due to a pinched nerve in your neck) are caused by degeneration of the discs between your spinal bones. These discs serve as small shock absorbers, and occasionally they are injured or herniated by wear and tear, trauma, or poor postural habits.
This may be referred to as a herniated disc or disc degeneration. When this happens, the disc may push out of place and pinch the nerves that travel from your spine to your shoulders and arms. Discs may also slowly compress over time, bringing your neck’s bones and joints closer together and causing pain.
Anterior cervical discectomy and fusion surgery may also be done for cervical spinal stenosis, a narrowing of your spinal canal.
Signs and symptoms of cervical disc herniation or degeneration may include:
- Neck pain
- Loss of neck range of motion
- Pain in your arm, forearm, or hand
- Numbness or tingling in your arm or hand
- Weakness in your arm or hand
- Sudden loss of balance and coordination
If you have any of these symptoms, you should see your doctor immediately. Your symptoms may be caused by something severe that requires immediate medical attention. Your doctor can perform special tests like an X-ray and MRI to determine if your cervical discs are causing your problem.
Your doctor may recommend that you try conservative treatments if you have pain due to cervical disc problems. These conservative treatments may include:
- Physical therapy
- Chiropractic care
- Spinal injections
- Massage therapy
If you fail to get adequate relief after attempting several weeks or months of conservative care, your doctor may recommend ACDF surgery to decompress your spinal nerves and restore motion to your neck. Most people who undergo the procedure enjoy the relief of their neck or arm pain.1
Risks and Contraindications
All surgery carries with it some risk, and an ACDF is no exception. Risks of ACDF surgery may include:
- Failure to relieve or worsening of symptoms
- Permanent weakness in one or both arms
- Difficulty swallowing food or water
- Difficulty with speech (your voice box is located directly in front of your cervical spine and may become injured during the surgery)
- Permanent paralysis or quadriplegia
Some people may benefit from ACDF surgery but have medical problems that prevent them from having the procedure. These may include things like osteoporosis, diabetes, or active cancer or metastatic disease.
While these risks and contraindications may sound scary, they are rare. In fact, most ACDF surgeries are quite successful with few complications, although a study shows rates are higher for higher-level surgery. Research of outpatient surgery for level 1 and level 2 ACDF indicates that complications occur in about 1 percent of cases, and most are handled easily within a four-hour window after surgery.
Your doctor can explain to you your specific risks of the procedure and what to expect from ACDF surgery.
Before the Surgery
When your doctor recommends ACDF surgery, you should spend some time asking him or her about the procedure. Questions to ask may include:
- Are there alternatives to the surgery?
- What happens if I elect to not have ACDF surgery?
- What happens during surgery?
- What is the post-operative recovery like?
- What are the risks of the procedure?
Prior to ACDF surgery, you need to do some things to prepare. These may include:4
- Exhausting all conservative measures
- Visiting your doctor for a physical
- Meeting with a cardiologist to check your heart
- Meeting with an anesthesiologist to discuss the procedure
- Planning your work schedule to allow for appropriate healing
- Meeting with your surgeon to understand the risks and benefits from ACDF surgery
- Signing necessary consent forms
- Contacting your health insurance to understand your financial responsibilities
- Avoiding smoking and consuming alcohol
Your doctor should tell you what to do as you prepare for ACDF surgery. If you have any questions, you should ask. Proper preparation ensures you maximize your chance of a successful procedure.
During the Surgery
Your ACDF surgery will take place in the hospital’s operating room. When you report to the hospital, the staff will take you to the pre-operative prep area where you will change into a hospital gown. You will meet with nurses and your doctor and anesthesiologist. An IV will be started, and you will be brought to the operating room. Anesthesia will begin and you will be asleep during the surgery.
Your surgeon will make an incision in the front part of your neck to one side of your windpipe. Dissection will be done, and your windpipe and food tube will be gently moved aside. Your surgeon will locate the front of your cervical spine. He or she will then remove the damaged disc material and use sharp surgical tools to cut away any bony arthritis that may be impinging upon spinal nerves. Care will be taken to ensure your spinal cord is not disturbed during this procedure.
Once your damaged spinal disc is removed, a small metal spacer will be inserted between the vertebrae where your disc once was. Then, a special compound will be used to fill in the space between the bones. Sometimes, this compound is mixed with small parts of your own bone (autograft) or with donor bone cells (allograft). This compound will fuse the two vertebrae together where the disc once was.
Once the bone fusion is done, a small metal plate will be attached to the front of the two vertebrae using tiny screws. This permanent plate helps hold the fused bones in place while healing takes place.
When the discectomy and fusion are complete, your food tube and windpipe are returned to their anatomical position, and the incision is closed with sutures. Your doctor, anesthesiologist, and nurses will monitor your condition throughout the surgery to keep you safe. Once the ACDF surgery is complete, you will be brought to the recovery area.
After your ACDF surgery, your doctor will meet with you in the hospital to discuss how the procedure went. You will likely spend one night in the hospital. Then you should be discharged home. Some surgeons perform the procedure on an outpatient basis.
Upon leaving the hospital, you may be required to do some things to ensure complete recovery. These may include:
- Attending physical therapy
- Wearing a neck brace
- Taking pain medication as prescribed
- Avoiding heavy lifting (usually avoid anything over five pounds)
- Start a light walking program to improve your stamina
You should avoid anything strenuous for about four to six weeks after ACDF surgery.
Your doctor and physical therapist will work with you to determine when it is safe for you to return to work. To ensure proper healing, you should avoid certain things after ACDF surgery. Things to avoid may include:4
- Heavy lifting
- Sexual intercourse
- Excessive bending or rotating of your neck
- Swimming or bathing (your doctor may allow you to shower with a waterproof neck brace.)
- Driving a motor vehicle
Your doctor can tell you when it is safe to start these normal functional activities. You should watch out for certain signs and symptoms that may indicate something is going wrong with your ACDF recovery. These may include:
- Excessive bleeding from the incision
- Swelling and redness around your incision
- Hoarseness of your voice that does not improve within a few days of surgery
- Difficulty swallowing medicine
- Severe and persistent headache
- Increased pain in your arm that does not improve within a few days of surgery
- Weakness or paralysis or your arm or hand
If you have any of these symptoms or suspect any problem with your surgery, it is always a good idea to check in with your doctor. He or she can determine if there is a condition that needs attention.
Recovery from ACDF surgery takes about six to eight weeks. Your course of healing may be slightly shorter or longer depending on your medical condition and the severity of your neck problem.
Many people benefit from a course of physical therapy after surgery. Therapy usually begins within a few weeks of ACDF surgery. Your physical therapist can assess your condition and prescribe exercises that can help you regain neck mobility, strength, and postural control. He or she can also help manage your pain and watch out for any problems that may occur after surgery.
Most people benefit from gentle exercise after ACDF surgery. Starting a walking program can be helpful to improve endurance and fitness while getting back to your normal lifestyle.
You should follow up with your doctor at regular intervals after anterior discectomy and fusion. Your doctor may take an X-ray every now and then to look at the position of your neck bones and the fusion site. He or she will assess the level of fusion taking place to ensure that you are healing properly.
On rare occasions, a problem called pseudoarthrosis occurs. This means that the fusion site between your vertebrae are not healing and surgery may need to be repeated. This is rare. Most patients enjoy a speedy recovery with a rapid return to previous activity within a few months of surgery.
If you are suffering from neck pain or arm pain due to cervical radiculopathy or degenerative disc disease, you may benefit from ACDF surgery. The surgery is designed to get pressure off of pinched spinal nerves. This can help decrease your pain and improve your overall function and mobility. The surgery has been proven to be an excellent option to help people with cervical disc problems quickly and safely get back to their normal activities.
- O’Neill KR, Wilson RJ, Burns KM, et al. Anterior cervical discectomy and fusion for adjacent segment disease: Clinical outcomes and cost utility of surgical intervention. Clin Spine Surg. 2016;29(6):234-41. doi:10.1097/BSD.0b013e31828ffc54
- Epstein NE. A review of complication rates for anterior cervical diskectomy and fusion (ACDF). Surg Neurol Int. 2019;10:100. doi:10.25259/SNI-191-2019
- Adamson T, Godil SS, Mehrlich M, Mendenhall S, Asher AL, Mcgirt MJ. Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases. J Neurosurg Spine. 2016;24(6):878-84. doi:10.3171/2015.8.SPINE14284
- Johns Hopkins Medicine Orthopaedic Surgery. The Road to Recovey After Cervical Spine Surgery.
- Rhee JM, Ju KL. Anterior cervical discectomy and fusion. JBJS Essent Surg Tech. 2016;6(4):e37. Published 2016 Nov 9. doi:10.2106/JBJS.ST.15.00056
- Mayfield Brain & Spine. Anterior Cervical Discectomy & Fusion. Updated November, 2018.