Cervical Spine Surgery:
Anterior Cervical Discectomy and Fusion (ACDF)
Below are some of the procedures offered by Dr. Cheng to treat cervical spine conditions. Click the links below to learn more about the selected treatment:
Anterior Cervical Discectomy & Fusion (ACDF) is an operation to remove a herniated disc (discectomy) in the neck. This surgery involves a 3–4 inch diagonal incision on the front (anterior) of your neck. Because the incision follows a natural skin fold, the resulting scar can be very cosmetic. The doctor protects the nerve roots and safely removes the herniated disc, eliminating pressure on the nerve. Next, bone graft is placed where the disc was, allowing the two vertebrae to grow together as one (fusion). Finally, a small metal plate may be screwed into place to hold the bone graft while the fusion heals.
The purpose of this surgery is to relieve arm/hand pain, numbness, weakness, or lack of coordination and fine motor control caused by pressure on the nerves. The success rate of relieving arm pain is very high.
The surgery typically lasts 2–2½ hours, depending on the number of discs operated upon, whether or not previous surgery has been performed, and the severity of pressure on the nerves. Blood loss is minimal so no blood donations are necessary before the operation. Time spent in the hospital is brief—most patients can go home one to two days after the surgery. The most common complaint of patients after this surgery is difficulty with swallowing. This is due to movement of the throat contents necessary to access the spine. This usually resolves over a few weeks after surgery, but may necessitate eating only liquids or soft solids during that period.
Patients usually wear a collar for 2-6 weeks. It is beneficial to sleep upright for approximately one week following surgery to help decrease swelling in the neck.
Risks of Surgery
Surgery and anesthesia involve stresses to many organs and tissues in the body. Incisions and handling tissues during surgery can result in many problems. The benefits of surgery must be carefully weighed against these risks. Some more common or serious problems are listed here.
Spinal Cord or Nerve Root Injury: Permanent injury to the spinal cord or nerve roots is extremely rare. It is not unusual, however to experience minor temporary tingling, numbness, weakness or pain which resolves over several weeks. All precautions will be taken but rarely, more serious nerve injuries may occur, effecting walking, balance, bowel or bladder functions.
Failure of fusion: On rare occasions the bone graft does not heal properly. The likelihood of this is greatly increased by smoking or using nicotine of any kind. This can cause the hardware to fail, and the bone graft may shift. In these cases, additional surgery may be needed. For this reason we recommend quitting smoking at least one month before surgery and refraining from smoking for at least 3 months after surgery. Smoking also causes more rapid degeneration of the spine, and continuing to smoke increases the likelihood of requiring treatment at another level of the neck.
Dural Tear: Leakage of spinal fluid can occur due to a tear in the tissue (called the “dura”) holding the spinal fluid and containing the nerves. On rare occasions additional surgery may be needed.
Infection: Infection is always a post-operative risk and occurs in approximately 1–2% of surgical patients, varying by surgery type. Infections may be superficial or deep into the bone. You are given antibiotics before and after the surgery to help prevent this complication. Please follow the instructions for wound care to help prevent infection.
Airway Compromise: Extremely rarely swelling within the neck can cause difficulty with breathing. If this occurs in the hospital, a breathing tube may need to be kept in place. If this occurs at home, it is an emergency and requires transportation to an emergency room.
Other complications: Other possible complications include blood clots, pneumonia and complications related to the general anesthesia. Persistent hoarseness and/or swallowing problems may last for several weeks. Please call us if this persists.
Activities and Exercise / Rehabilitation
Adequate rehabilitation is crucial for a successful result. Many patients with spinal injuries have suffered from spinal pain for some time. This may result in considerable weakening of the spinal muscles due to lack of exercise, so you should return to your normal activities slowly.
The primary form of rehabilitation after ACDF is an aggressive walking program. You should start immediately after discharge, walking more and more each day. In general, we recommend two to three episodes of exercise per day. The average patient can be walking 15 minutes twice a day by their first postoperative visit and 30–40 minutes twice a day by six weeks after surgery. Walk more if you are so inclined!
Patients routinely experience a dramatic, remarkable reduction in their arm pain. If the nerve has been irritated for a long time, then a more gradual reduction of the arm pain is to be expected. As the nerve heals, expect tingling or a warm feeling. Depending on how long the symptoms have been present, strength is usually the second symptom to improve. Numbness in your arm / hand is the last to resolve and, if present for long enough prior to surgery, may be permanent.
Neck pain associated with the incision is largely improved within two to three weeks. Increased pain with prolonged sitting and driving is also expected and, for safety reasons, we recommend refraining from driving for approximately three weeks.