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Anterior Cervical Discectomy and Fusion (ACDF) is a procedure that relieves pain caused by cervical radiculopathy, or pinched nerves in the neck. The "discectomy neck" procedure removes a damaged or herniated disc to alleviate pressure on the nerves, while the “fusion” procedure fuses adjacent vertebrae using a bone graft or implant for stability. This condition typically results from disc herniation or nerve root compression in the cervical region.
ACDF is mostly seen in older men above 60, with spondylosis being the major cause. In younger populations, radiculopathy is a common cause of cervical disc herniations. Although effective, the procedure carries certain risks and potential complications. Understanding these risks can help patients make informed decisions, which can help them prepare for the procedure wisely.
Synopsis
How is Anterior Cervical Discectomy and Fusion Surgery Carried Out?
A brief examination determines whether the patient is a good candidate for ACDF. The procedure is usually performed using a minimally invasive approach. However, depending on the patient's condition and severity, ACDF may also be carried out using traditional methods.
During the ACDF surgery, anaesthesia is administered, and an incision is made in the neck. An operating microscope and other specialised instruments are inserted through the incision for better vision of the affected cervical region. The bone spurs and damaged discs are then removed.
After removal, spinal fusion is performed, and grafts (patient’s bone, synthetic material, or donor bone) are placed through the soft disc. After placing the graft, it is fixed to the vertebrae with metal plates and screws. Post-surgery, new bone cells will grow around the graft, and after 3-6 months, the two vertebrae are fused as one.
Risks Associated with Anterior Cervical Discectomy and Fusion Surgery
Even though ACDF is a key procedure for the treatment of herniated discs in the cervical region, complications are of significant concern. Common risks that can occur with the procedure include the following:
- Dysphagia
Difficulty in swallowing, or dysphagia, is a complication that may arise among those who have undergone ACDF. It often leads to longer hospital stays and higher readmission rates after the procedure. Some studies pointed out that grafts soaked with bone morphogenetic protein (BMP) were associated with higher dysphagia rates. Moreover, obesity, as well as females, have been found to have prevertebral soft tissue swelling (PVSTS), a complication associated with airway obstruction.
- Oesophageal Perforation
Oesophageal perforations, which are holes present in the food pipe, occur rarely after ACDF. The complication in most cases is detected through symptoms, which include difficulty and/or painful swallowing, sepsis, wound draining, coughing blood, weakness in all limbs, recurrent pneumonia, meningitis, and expulsion of hardware like screws or plates.
- Recurrent Laryngeal Nerve Palsy
Recurrent laryngeal nerve palsy occurs when there is hoarseness, vocal cord paralysis, or dysphonia after ACDF. The complication mostly occurs in multi-level procedures and revision surgeries and is seen as one of the most common risks among those who have undergone the procedure. Patients with RLN complications recover either partially or fully.
- Graft and Hardware Failure
Complications of screw breakage or pullout, screw loosening, plate fracture, graft migration, or fracture can occur, even after years post-surgery. Graft migration can occur if plates and screws are not used. It can also happen if more than one vertebral levels are fused. Although rare, it necessitates revision surgery if it occurs.
- Haematoma
Cervical haematoma, although rare, can be serious, and early intervention can prevent severe complications. Some risk factors that can cause haematoma are if patients undergo multilevel ACDF, have a low body mass index (BMI), use BMP-soaked grafts, have comorbidities like chronic kidney disease (CKD), or have ASA Class >3, which denotes high risk (a classification used by the American Society of Anaesthesiologists to assess the risk of the patient).
- Cerebrospinal Fluid (CSF) Leak
In rare cases, the protective fluid around the brain and spinal cord escapes because of a tear in the dura covering the spinal cord, causing CSF leakage. High risks for CSF leakage post-ACDF usually include those who have undergone revision surgeries and in cases where ossification of the posterior longitudinal ligament (OPLL) is present.
Conclusion
Other complications of ACDF include Horner syndrome, vertebral artery injury, new or worsened neurological deficit, vascular complications, cranial nerve injury, and so on. These complications are rare, and medical professionals will conduct a thorough risk-benefit analysis to ensure the benefits outweigh the risks.
At Manipal Hospitals, Mukundapur, our specialists at the Department of Neurology prioritise patient safety by employing advanced techniques and personalised care. For any issues related to the brain and spinal cord, patients can rely on Manipal Hospitals for complete and world-class treatment.
FAQ's
ACDF is a surgical procedure used to treat cervical radiculopathy (pinched nerves in the neck) caused by a herniated or damaged disc. The surgery involves removing the damaged disc and fusing two adjacent vertebrae to relieve pressure on the nerves and provide stability to the spine.
The duration of ACDF can vary. In most cases, it takes around one to two hours. Our neurologists will give you a complete picture of the surgery, including its duration, in case you are suggested one.
Cervical disc herniation, also called a slipped disc, is a condition where the central gel-like part of your intervertebral disc ruptures or protrudes outside, pressing the nerve root. This can cause sharp or burning neck pain, along with sensations of tingling and numbness.
Expected recovery times can differ for different patients, and are based on general health, age, and severity of the condition. It usually takes, however, six months to a year for bone solidification around the graft in your neck.
General recovery instructions include light walking and sitting post-ACDF, performing light activities, avoiding strenuous routines, and sticking to follow-ups and medication schedules. You need to discuss with our specialist regarding your return to work. In most cases, physical therapy will be recommended. It is imperative to stick to those exercises for optimal recovery.
The procedure can help relieve nerve compression, reduce pain, and improve mobility. It also helps stabilize the spine, which can prevent future issues in the treated area.
The surgeon makes an incision in the front of the neck, removes the damaged disc, and inserts a bone graft or synthetic material to fuse the vertebrae. In some cases, plates or screws may be used for additional stability.
ACDF helps relieve neck pain, radiating arm pain, numbness, and weakness caused by nerve compression due to herniated discs, spinal stenosis, or degenerative disc disease.
To schedule an appointment at Manipal Hospitals, Mukundapur, contact our Neurology Department or visit our website.
Visit: https://www.manipalhospitals.com/mukundapur/specialities/neurology/
Contact no: 03369070001
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