An anterior cervical discectomy and fusion (ACDF) is a surgical procedure where a small incision is made on the front (anterior) portion of the neck (cervical). The intervertebral disc is removed (discectomy) and bone graft is placed into the space between the two vertebrae to enable them to grow together (fusion) into one bone. A plate and screws are also commonly placed in order to stabilize the two bones as the fusion takes place. This procedure is most commonly performed to relieve pain, numbness, and/or weakness in the shoulder and arm. In addition, patients with spinal cord compression often require surgery to prevent further deterioration. Surgery has unpredictable results at relieving chronic neck pain. This is because neck pain is often from a combination of arthritic facet joints, degenerative discs, and inflammation of soft tissues around the neck. Chronic neck pain is often best treated with physical therapy and other non-operative treatments.
Additional Questions for a Fusion
Will a fusion limit my motion?
Most patients do not notice a significant loss of motion when one-level in their spine is fused. The other levels in their spine typically make up for any loss of motion at the fused level. Patients may notice some slight loss of motion when two adjacent levels are fused in their spine. Fusions involving three levels or more may cause more noticeable loss of motion. This can vary from patient to patient depending on the condition of their spine prior to a fusion.
Why is hardware (i.e., screws, rods, plate, etc…) often used for a fusion?
Good biology and stability are essential for a fusion. The biologic process of a fusion is similar to a fracture. When you remove the intervertebral disc and cartilage between two vertebrae the body thinks there is a fracture. Bone cells are recruited to produce bone to stabilize the perceived fracture. During surgery bone graft from the patient and/or cadaver is used to fill the disc space. This bone acts as scaffolding for new bone to grow. Hardware such as plates, rods, and screws are often used to limit motion at the level to be fused. Too much motion can lead to the production of fibrous tissue rather than bone. This can lead to a nonunion whereby there is still motion between the two bones since fibrous tissue is not as strong as solid bone. The hardware could be removed after the fusion is complete (3-12 months). However, this is rarely done since most patients do not have symptoms from their hardware.
When can I take anti-inflammatories?
Anti-inflammatories (i.e., Aleve, ibuprofen, Diclofenac, etc…) should be stopped 7 days prior to surgery since they can cause increased bleeding at the time of surgery. This can add unnecessary surgery time. Following a fusion, one should refrain from taking any anti-inflammatories for 3 months since they can also inhibit bone healing.
Does nicotine affect the healing of bone?
Yes, nicotine in many tobacco products inhibits bone growth. Nicotine also leads to weaker bone and makes it more difficult for soft tissues to heal. Since nicotine is believed to be the culprit, chewing gum containing nicotine and other smokeless nicotine products have the same negative effects on bone healing. Prior to undergoing a fusion it is recommended to refrain from using any products containing nicotine for at least 6 weeks. A patient should not use nicotine products for at least 3 months following a fusion. Due to all the other harmful effects of nicotine and tobacco, it is advised to quit all together.