ANTERIOR CERVICAL DISCECTOMY AND FUSION

The Risks Associated with ACDF Surgery

Every surgical procedure carries some risks, and Anterior Cervical Discectomy and Fusion (ACDF) is no exception. Here are some potential complications:

General Surgical Risks

• Bleeding: There’s always a risk of significant blood loss.
• Infection: Post-surgical infections can occur at the surgical site.
• Blood Clots: Deep vein thrombosis (DVT) can develop, potentially leading to serious conditions if not managed.
• Anesthesia Reactions: Some patients may have adverse reactions to anesthesia.

ACDF-Specific Risks

• Hoarseness and Swallowing Difficulties: During surgery, doctors must pay attention to the recurrent laryngeal nerve, which controls vocal cords. Temporary hoarseness can occur and can last several months. In rare cases, issues with swallowing and persistent hoarseness may necessitate further treatment from specialists.
• Vertebrae Failing to Fuse: Sometimes, the bones intended to fuse may not do so. Factors like smoking, osteoporosis, obesity, and malnutrition can impede the fusion process. Smoking, in particular, introduces toxins that can inhibit bone formation, significantly undermining the procedure.
• Hardware Complications: Metal plates and screws, also known as “hardware,” are used to stabilize the spine. These can occasionally move or break before the bones fully fuse. Such cases may require additional surgery to correct or replace the hardware.
• Bone Graft Migration: In rare instances, the bone graft used in the surgery might shift from its intended position. This can occur if by eliminating hardware or if multiple vertebral segments become fused. Doctors may need to conduct corrective surgery if this occurs.
• Adjacent Segment Disease: When a spine segment becomes fused, additional stress occurs on the adjacent discs and vertebrae. Over time, this can lead to degeneration of these areas, causing pain and discomfort.
• Nerve Damage or Persistent Pain: Any spine surgery poses a risk to the nerves or spinal cord. Damage can result in numbness or paralysis. Persistent pain can occur because of nerve damage stemming from the original disc herniation. In some cases, pre-existing nerve damage may not respond to surgery, requiring other treatments such as spinal cord stimulation.

Understanding these risks can help you make a more informed decision about undergoing ACDF surgery. Always consult with your doctor to weigh the benefits and potential complications.

Summary

The decision to perform ACDF occurs after a thorough evaluation of the patient’s symptoms, medical history, physical examination, and diagnostic imaging (such as X-rays, MRI, or CT scans). Surgeons consider factors such as the severity of symptoms, the extent of spinal cord or nerve compression, and the patient’s overall health when determining if ACDF appears as the appropriate treatment option.

Patients need to consult with a qualified spine specialist or surgeon to receive an accurate diagnosis.  With the diagnosis, doctors will formulate a personalized treatment plan tailored to the patient’s specific needs.

Candidates for ACDF Surgery?

ACDF surgery, or Anterior Cervical Discectomy and Fusion, is often recommended for individuals facing certain spinal conditions and symptoms that haven’t responded to more conservative treatments. Here are some specific scenarios where patients need ACDF Surgery:

Conditions that Benefit from ACDF Surgery

Herniated Disc:

• When the soft, gel-like center of a spinal disc protrudes through its outer layer, it can press on nearby nerves, causing pain and discomfort. If this condition, known as herniation, leads to significant pain that radiates down the arm or other neurological deficits, doctors will consider ACDF as a suitable option.

Degenerative Disc Disease:

• This occurs as spinal discs lose hydration and shrink over time, which can cause the vertebrae to come into closer contact and pinch the nerves. Symptoms such as chronic neck pain, arm pain, and numbness could make an individual a good candidate for ACDF.

Cervical Stenosis / Myelopathy:

• This condition involves the narrowing of the spinal canal, which can put pressure on the spinal cord. Doctors will advise that the cause can occur from enlarged facet joints, thickened ligaments, or bulging discs. Symptoms include pain, weakness in the arms or legs, and difficulty walking. ACDF can alleviate these issues by removing the problematic disc and stabilizing the spine.

Symptoms Indicating the Need for ACDF Surgery

Persistent Arm Pain:

• If the pain in your arm is more severe than neck pain and doesn’t improve with physical therapy or medication, doctors may recommend ACDF.

Significant Weakness:

• Noticeable weakness in the hand or arm that affects daily activities can also indicate that you may benefit from this surgical procedure.

Unresolved Symptoms:

• When non-surgical treatments such as physical therapy or medications fail to provide relief, doctors will consider surgical intervention through ACDF.

By addressing these conditions and symptoms, ACDF aims to relieve pain, restore function, and improve quality of life. If you have any of these issues and conservative methods haven’t worked, consult with a spine specialist to see if you are a candidate for ACDF surgery.

The Anterior Cervical Discectomy and Fusion Procedure

Anterior cervical discectomy and fusion (ACDF) refers ti a surgical procedure performed to treat certain conditions affecting the cervical spine (neck region). Surgeons use this procedure to address herniated discs, degenerative disc disease, spinal stenosis, or spinal instability in the cervical spine.

The following describes the ACDF procedure:

• Anesthesia: The patient undergoes general anesthesia, ensuring they are asleep and pain-free throughout the surgery.
• Incision: The surgeon makes a small incision in the front of the neck, usually along a natural skin crease. This allows direct access to the affected cervical spine. The surgeon makes a 2-inch skin incision on the right or left side of the neck. The surgeon creates a tunnel to the spine by moving aside muscles and retracting the trachea, esophagus, and arteries. The surgeon moves the muscles that support the front of the spine and holds them aside so the surgeon can see the bony vertebrae and discs.
• Discectomy: The surgeon carefully moves aside structures like muscles, blood vessels, and the windpipe to reach the affected disc or discs. With the aid of a fluoroscope (a special X-ray), the surgeon passes a thin needle into the disc to locate the affected vertebra and disc. The surgeon will remove the problematic herniated or degenerated disc. This helps alleviate pressure on spinal nerves and the spinal cord. The outer wall of the disc is cut, and the surgeon removes about two-thirds of the disc using small grasping tools, then looks through a surgical microscope to remove the rest. The ligament behind the vertebrae also gets removed to reach the spinal canal and ensure any disc material pressing on spinal nerves is cleared.
• Nerve Decompression: The surgeon will remove any bone spurs that press on the nerve root. The foramen, through which the spinal nerve exits, becomes enlarged with a drill in a procedure called a foraminotomy, giving the nerves more room to exit the spinal canal.
• Bone Graft Placement: After removing the damaged disc, the empty disc space needs stabilization. To achieve this, the surgeon places a bone graft in the space previously occupied by the disc. Our surgeons can take the bone graft from the patient’s own body.

Types of Bone Grafts for ACDF

• Autograft: This type of graft uses your living bone, often harvested from the hip (iliac crest) or drillings during the surgery. The marrow contains bone-growing proteins, which contribute to a higher rate of fusion. However, the disadvantage is the potential pain at the harvest site in your hip.
• Bone Marrow Aspirate (BMA): This involves collecting bone marrow with a syringe, typically from the hip (iliac bone) or vertebra. Compared to an iliac crest graft, this method is relatively painless. BMA is used to provide a source of living bone cells without the need for a more invasive procedure.
• Allograft: This type of graft uses bone from an organ donor, collected and stored by a bone bank. Unlike autografts, allografts do not contain bone-growing cells or proteins. However, surgeons may pack them with shavings of living bone tissue taken from your spine during surgery, making them a viable option for many patients.
• Cellular Bone Matrix: This is a specialized form of allograft that includes bone-growing stem cells. It is often shaped into a putty and added to the graft site to promote bone growth more effectively.
• Bone Morphogenetic Protein (BMP): Sometimes added to bone graft material, BMP stimulates bone growth naturally within the body. It can combine with either autografts or allografts to enhance the fusion process.

Understanding Bone Grafs

By understanding the different types of bone grafts available, you can have a more informed discussion with your surgeon about the best option for your specific condition.

• Bone graft from your hip: A skin and muscle incision is made over the crest of the hipbone. A chisel is used to cut through the hard outer layer (cortical bone) to the inner layer (cancellous bone), which contains bone-growing cells and proteins. The graft is then shaped and placed into the space.
• Bone bank or fusion cage: A cadaver bone graft or bioplastic cage is filled with leftover bone shavings containing bone-growing cells and proteins, and then tapped into place.
• Fusion: To promote the fusion of the adjacent vertebrae, additional support is provided using a plate and screws. The plate consists of metal and the surgeon will secure it to the vertebrae, holding them in the correct position during the fusion process. Over time, the bone graft fuses with the adjacent vertebrae, creating a solid and stable spinal segment. The bone graft is often reinforced with a metal plate screwed into the vertebrae to provide stability during fusion. An X-ray is taken to verify the position of the graft, plate, and screws.
• Alternative Option: Artificial Disc Replacement: Instead of a bone graft or fusion cage, doctors will insert an artificial disc into the empty disc space. In select patients, this option may preserve the motion of the spine segment.
• Closure: The surgeon carefully closes the incision using sutures or staples. The spreader retractors are removed, and the muscle and skin incisions are sutured together. Steri-Strips or biological glue are placed across the incision to ensure proper wound healing and minimize scarring.

Summary

Post-surgery, patients may need to stay in the hospital for a day or two for monitoring. They are typically advised to wear a neck brace or collar to support the healing process and provide stability to the neck. The doctor may recommend rehabilitation and physical therapy to help restore neck strength and flexibility.

ACDF is a well-established procedure with a high success rate in providing pain relief and restoring spinal stability in suitable cases. However, the specific details of the surgery may vary depending on the individual patient’s condition and the surgeon’s approach. It’s important to consult with a qualified spine specialist or surgeon to determine if ACDF is the appropriate treatment option for your specific condition.

What are the Success Rates of ACDF Surgery Pain Relief?

• Arm Pain: Relieved in 92 to 100% of patients.
• Neck Pain: Relieved in 73 to 83% of patients.
• Arm Weakness and Numbness: May persist for weeks to months.

In general, people with arm pain benefit more from ACDF than those with neck pain. Maintaining a positive attitude and diligently performing your physical therapy exercises can also contribute to better outcomes.

Spinal Fusion Success Rates

Achieving a spinal fusion varies depending on the technique used and the patient’s overall health. A study comparing three techniques provided the following outcomes:

• ACD (no bone graft): 67% achieved fusion naturally, though this method can result in an abnormal forward curving of the spine (kyphosis).
• ACDF with bone graft: 93% achieved fusion.
• ACDF with bone graft and plates/screws: 100% achieved fusion.

These statistics highlight the importance of discussing surgical techniques with your spine specialist to choose the best option tailored to your condition.

Anterior Cervical Discectomy and Fusion Recovery

Understanding the recovery process can help patients prepare themselves physically and mentally for the journey ahead.

• Post-Surgical Care: After ACDF surgery, patients are usually admitted to the hospital for a brief period.  Normally, the patient stays in the hospital for one to two days for post-operative care.
• Neck Immobilization: To support the healing process and minimize stress on the surgical site, the doctor may prescribe a cervical collar or brace. This device restricts movement and helps maintain proper alignment of the cervical spine.
• Pain Management: Pain Management: Pain and discomfort are normal aspects of the recovery process. To alleviate these symptoms, healthcare providers prescribe pain medications, typically in the form of oral analgesics.

Pain Medicine Usage

• Follow Instructions: Take pain medicines as directed by your healthcare provider. Gradually reduce the amount and frequency as your pain subsides. If you don’t need the pain medicine, don’t take it.

Managing Side Effects

• Constipation: Narcotics can cause constipation. To mitigate this, drink plenty of water and consume high-fiber foods. Over-the-counter stool softeners and laxatives such as Colace, Senokot, Dulcolax, and Miralax can help.

When to Seek Further Help

• Persistent Constipation: If painful constipation does not improve, contact your doctor to discuss alternative medications or treatments.

Medication Warnings

• Anti-inflammatory Pain Relievers: Avoid taking anti-inflammatory pain relievers like Advil or Aleve without your surgeon’s approval. These medications can prevent new bone growth and may compromise your fusion.
• Alternative Pain Relief: You may take acetaminophen (Tylenol) as an alternative for managing pain.

By following these guidelines, you can effectively manage pain and reduce complications during your recovery process.

• Physical Therapy and Rehabilitation: Physical therapy is an integral part of the recovery process following ACDF surgery. The timing for initiating physical therapy may vary based on the surgeon’s recommendation and the patient’s progress. Physical therapists will guide patients through exercises and stretches aimed at restoring neck strength, flexibility, and overall function.
• Returning to Daily Activities: Returning to regular daily activities is a gradual process that the patient should approach with caution. Patients are typically advised to avoid strenuous activities. For instance, patients should not engage in heavy lifting and excessive bending or twisting of the neck during recovery. Additionally, it’s crucial to follow specific post-operative care guidelines to ensure a smooth recovery:

• Brace Usage: If you were given a brace, wear it at all times except when sleeping, showering, or icing.
• Icing Instructions: Ice your incision 3-4 times per day for 15-20 minutes to reduce pain and swelling.
• Walking Recommendations: Get up and walk for 5-10 minutes every 3-4 hours. Gradually increase walking as you are able.

Following the Doctor’s instructions

By adhering to these detailed instructions, patients can support their recovery process and minimize potential complications.

• Follow-Up Appointments: Regular follow-up appointments with the surgeon are essential to monitor the progress of the recovery and assess the surgery. During these appointments, the surgeon may perform imaging tests to evaluate the fusion’s success and address any concerns or complications.
• Emotional and Mental Well-being: Recovery from ACDF surgery not only involves physical healing but also emotional and mental well-being. It is natural to experience a range of emotions, including anxiety, frustration, or impatience during the recovery process.

Summary

Recovery from Anterior Cervical Discectomy and Fusion requires adherence to post-operative instructions and active participation in the rehabilitation process. By understanding the recovery journey and collaborating closely with healthcare professionals, patients can optimize their chances of a successful outcome. Remember, every individual’s recovery timeline may vary, and it is essential to consult with the surgeon for personalized guidance throughout the process.

Why Choose the Southwest Scoliosis and Spine Institute?

Patients should choose the Southwest Scoliosis and Spine Institute for the anterior cervical fusion procedure due to the institute’s commitment to excellence and our team of highly skilled doctors and surgeons consisting of Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD.  With a focus on scoliosis and spine conditions, the institute with offices in Dallas, Plano, and Frisco, Texas has developed specialized expertise in performing this procedure. The surgeons at the Southwest Scoliosis and Spine Institute with offices in Dallas, Plano, and Frisco, Texas have undergone extensive training and possess vast experience in anterior cervical fusion, ensuring that patients receive the highest quality of care. Their dedication to staying up-to-date with the latest advancements in surgical techniques and technologies allows them to deliver exceptional results.

Moreover, the institute’s multidisciplinary approach ensures that patients receive comprehensive and personalized treatment plans tailored to their specific needs. By choosing the Southwest Scoliosis and Spine Institute, patients can have confidence in the expertise and skill of the surgeons.  Furthermore, patients have our commitment to providing outstanding surgical outcomes and compassionate care.

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Medtronic: Anterior Cervical Discectomy and Fusion