Lateral view of the post-operative x-ray shows the result of
the anterior cervical fusion at C5-C6.
Anterior Cervical Discectomy and Fusion (ACF) is a surgical procedure designed to take the pressure off of the spinal cord or the exiting nerve roots in the cervical spine. Disc material or bone spurs may create pressure on the nerve roots. The nerve endings often become inflamed causing serious pain, progressive numbness, and weakness over time. An ACF surgery is a reasonable treatment option when imaging studies (x-rays and MRI) demonstrate evidence of degenerative disc disease, as well as pressure on the spinal cord or exiting nerve roots.
To avoid damaging the spinal cord, an ACF surgery is done from the front. Using either an incision on the right or left side of the neck, the spinal surgeon will carefully move the trachea and esophagus toward the center of the neck, while moving the major blood vessels in the neck toward the side. This allows access to the front of the cervical spine. Disc material is essentially removed by going through the disc itself, until the spinal cord and exiting nerve roots are clearly visualized. This effectively treats the compression of the nerves and the arm pain and numbness. However, it does nothing to eliminate neck pain. A number of years ago, it was appropriate to simply remove the disc and allow the bones to stick together, leaving many people with disabling neck pain. Today, some type of spacer is inserted in the place of the disc. In certain cases, the spacer is an artificial disc. In other cases, it may be made of donor bone, titanium, or plastic. The spacer is used to maintain the normal relationship of spacing of the bones of the spine, while allowing them to heal in the correct position. The slow process of the bones healing is called fusion.
After the spacer is inserted and the bony structures are realigned, the patient may either be placed in a stiff cervical collar for a period of three months or have a small titanium plate attached with small screws to the front of the spine. The plate acts as an internal cast to stabilize the spine and allow healing of the bones. In many cases, patients have very little discomfort from the operation. They may stay overnight in the hospital and return home very rapidly. Some mild hoarseness and difficulty swallowing may be present for the first few days after this procedure; however, most people are back at work within a few weeks or months depending on their specific occupation.
Although most patients feel relief nearly immediately from the neck and arm symptoms, the bones actually take months to heal. X-rays do not show signs of bony healing until six months after the procedure. Typically, fusion is not complete until one year after the initial surgery.
- Brian R. Subach, MD, FACS; Virginia Spine Institute
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