Anterior Cervical Discectomy & Fusion
If you have a herniated disc or a degenerating disc in your cervical spine, the seven vertebrae that make up the neck, the odds are good that either the spinal cord or the nerve roots exiting the spine are receiving some unwanted pressure from your failing disc. This often leads to chronic neck and back pain that can radiate out into the arms and hands.
Dr. Lipani performs a decompression surgery, known as an anterior cervical discectomy and fusion, to remove the damaged disc and fuse the two cervical vertebrae together.
What Is An Anterior Cervical Discectomy & Fusion
Anterior Cervical Discectomy and Fusion (ACDF) is a standard surgical procedure used to remove a herniated or degenerated disc from the cervical (neck) area of the spine. ACDF is the most commonly used procedure for this type of condition and usually provides excellent results.
When ACDF is performed, Dr. Lipani opens the front (anterior) of the neck area (cervical) so as not to disturb the spine, spinal cord, or strong muscles in the back of the neck, and removes one or more discs from the spine (discectomy). Dr. Lipani then fills the area with a bone graft (fusion), which may be held in place by metal plates and screws. When the body begins its natural healing process after surgery, new bone cells will grow around the bone graft, creating a single piece of bone to join the vertebrae above and below the discectomy. If metal plates and screws have been used, bone may grow around these and reinforce them.
Candidates for Anterior Cervical Discectomy & Fusion
Some symptoms that may indicate that a patient is a candidate for ACDF are significant numbness or weakness in limbs, especially hands and arms, and significant arm pain which may be accompanied by neck pain. Patients will first have diagnostic tests, such as MRI, CT scan, and/or myelogram to determine the presence of a herniated or degenerative disc. Even after a diagnosis is made, patients will still discuss non-surgical options with their orthopedic surgeon before proceeding. Non-surgical treatments can be highly successful in diminishing the symptoms of herniated discs, and may even heal herniated discs after a few months.
Prior to electing to have Anterior Cervical Discectomy & Fusion, Dr. Lipani and the patient will also discuss different types of bone grafts. This includes grafts from the patient’s own bone (autograft), grafts from donor bone (allograft), and bone grafts from man-made materials. To make sure the patient is completely happy with the process.
What Are the Goals of ACDF Procedures?
The primary goal of this surgery is to relieve the patient’s chronic pain by removing the source of pressure on the compressed nerves in the neck. Other goals of the surgery include:
- Improving neck pain
- Maintaining spinal stability
- Improving spinal alignment
- Preserving range of motion in the neck
What Conditions Can Anterior Cervical Discectomy and Fusion Treat?
When a cervical disc herniates or degenerates to the point where it allows pressure to build on nearby nerves, there are some common sources of pain that surgery will correct.
- Neck pain — This pain is typically felt toward the back or side of the neck. This pain can range from mild pain that is tender to the touch to a sharp, burning pain.
- Radicular pain — This pain radiates from the compressed nerve in the neck down through the shoulder, arm, hand, and/or fingers. This pain can feel hot or like an electric shock.
- Numbness, tingling, or weakness — The area served by the compressed nerve roots can become progressively more and more affected as the nerve receives more pressure. This shows itself in numbness, tingling, and growing weakness in the area. For instance, it may become more and more difficult to perform fine motor skills with your fingers. At this point, if the nerve is not decompressed there is danger of permanent nerve damage.
- Neck stiffness — Pain and inflammation from a herniated or damaged cervical disc will usually restrict the neck movement and range of motion for the patient.
How To Prepare For ACDF Surgery
The most important thing a patient can do to ensure a successful ACDF surgery is to cease all tobacco use. Nicotine inhibits bone growth, which prevents the body from creating bone cells to fuse the graft and the vertebrae, and decreases blood circulation, which slows healing and increases infection risk. Failed fusion, in which the bone graft does not successfully fuse the two vertebrae, is five times more likely for smokers than non-smokers. If you smoke, please talk to your doctor about the many ways available to help you quit.
Dr. Lipani will give you more information about how to prepare for your surgery, including showering beforehand and wearing clean clothes, not wearing jewelry or makeup, wearing practical footwear, taking your regular medications, and bringing a list of all your medications (including all prescription, non-prescription, and herbal supplements that you take) and allergies with you.
After giving the patient anesthesia and preparing the hip area if an autograft will be used, Dr. Lipani makes a small incision at the front of the throat area either to the left or right of direct center and moves the esophagus, trachea, and muscle tissue to the side to expose the vertebrae and discs. Dr. Lipani then uses a fluoroscope to help find the problem vertebra and disc. He uses a spreader to gently separate the discs above and below the disc to be removed, cuts the wall of the disc, and then uses special grasping tools to remove most of the disc. Finally, he uses a microscope to help pull out remaining pieces of the disc. Ligament running behind the vertebrae is removed so that any remaining disc material or bone spurs pressing on the spinal nerves can be removed.
After the disc is removed, Dr. Lipani uses a drill to prepare a space in the vertebrae above and below the removed disc, so that they can better hold the material for the bone graft and expose the graft to the inner cells of the vertebrae, which contain blood cells and proteins necessary for bone growth. He places the bone graft or man-made bone graft material into the space and may secure it place with screws and a plate.
Finally, Dr. Lipani removes the spreaders and closes the muscles and skin at the incision with sutures. He then places sterile bandaging and/or biologic glue across the incision. After surgery, patients are taken to a recovery area where their vitals and pain level are assessed. Most ACDF patients are able to go home the same day, and are prescribed pain medication for a limited time period. Full recovery takes four to six weeks.
What Will Recovery Be like After ACDF Surgery?
One advantage to the anterior approach for this fusion surgery is that the pathway to gain access to the spine and affected disc is uncomplicated. This makes for less incisional pain for the patient than with a posterior operation.
Most of our ACDF patients are able to go home the same day of their surgery. This is not a difficult recovery, but there will likely be some issues. These are a couple potential challenges to recovery from this surgery:
- Pain away from the incision area — In some patients the most bothersome pain isn’t at their incision site or in the neck, but elsewhere. Fusion can create pain with the attached muscles and their biomechanics, so you may have pain in the upper back and shoulders. You may have some pain in the hip area, if a graft was taken. Your arm pain and tingling usually doesn’t immediately vanish, and it could actually feel worse for a couple weeks before it turns the corner.
- Swallowing difficulties — For the first couple of days after surgery, you’ll need to be on a liquid diet because swallowing will be difficult. From there, you can work into soft foods like yogurt and applesauce.
- Speaking — When you speak, you’ll have some hoarseness and probably coughing for a few days. Some patients can only speak in whispers for a couple weeks.
Most patients fully recover after ACDF surgery with Dr. Lipani in from 4 to 6 weeks. Some patients can return to most everyday activities after just a few days. For the fusion to fully mature, where it heals into one solid, strong piece of bone rather than two, it will take a full year to 18 months.
What Are the Risks Involved with ACDF Surgery?
This is a pretty low-risk procedure. Obviously, there are risks involving anesthesia reactions, infection, and poor wound healing, as are present with any surgery. For ACDF surgery, these are potential complications:
- Long-term pain at the location of the bone graft
- Difficulty swallowing
- Difficulty speaking
- Infection of the incision or any tissue affected by the surgery
- Infection of the vertebrae
- Excessive bleeding
- Pain is not fully relieved
- Failure of the bone graft to solidly fuse
- Nerve root damage
- Damage to the trachea/esophagus
What Are Alternative Procedures to ACDF?
ACDF is a highly successful procedure, but fusion may not be the best option, particularly for younger patients. This is because in a younger patient, long-term fusion can lead to what is known as adjacent segment disease. This is the accelerated degeneration of the joints above and below the fused vertebrae.
One alternative for these patients is artificial disc replacement, where the damaged disc is still removed, but it is replaced with an artificial disc instead. This allows for continued motion between the two neighboring vertebrae.
A cervical laminoplasty can increase the size of the spinal canal, eliminating compression and pain. This can be especially useful for multilevel disease where you don’t want to fuse a series of vertebrae together.
Schedule A Consultation
If you suffer from a herniated disk, anterior cervical discectomy & fusion may be the right treatment for you. Contact our New Jersey office at 609-890-3400 to schedule a consultation with Dr. John Lipani.