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 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. John 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 Surgery
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.
Goals Of The ACDF Procedure
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 Surgery 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.
Preparing 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.
How the ACDF procedure is performed
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.
How Long Does ACDF Surgery Take?
ACDF surgery may take three or more hours, though it can often be completed within one to two. There are several factors, including how many levels need to be decompressed and fused, and the extent of damage and disease present, that will play a direct role in how long your procedure will take.
At Princeton Neurological Surgery, we are committed to providing accurate information to each patient. While you are with us, we will discuss how long you can expect to be in surgery, what will be required in preparation, and what you can expect afterward to help ensure you are ready for your procedure.
Are There Any Risks Associated With ACDF Surgery?
There are risks, such as bleeding and infection, possible with any surgical procedure. ACDF is no exception. While complications are rare, risks associated with this procedure include:
- Damage to the esophagus
- Difficulties swallowing
- Speech irregularities
- Airway compromise
- Nerve or spinal cord damage
- Dural tear
- Spinal fluid leak
You can help to reduce your risks by following all of the pre and postoperative directions provided by our office. We can provide additional information on potential risks and complications during your initial consultation to help ensure you make the right decision for your needs.
Will I Be Required to Wear a Brace After My Anterior Cervical Discectomy & Fusion?
Some, but not all patients will require a neck brace following ACFD surgery. Bone fusion is not impacted by neck movement following this procedure, making a neck brace unnecessary in most cases.
Are the Results of My ACDF Surgery Permanent?
During ACDF surgery, herniated or degenerated discs are removed from the cervical spine, allowing the discs above and below to fuse. When bones fuse properly, the results can be permanent, although secondary surgeries are not entirely uncommon.
Taking care of your body, getting proper nutrition, avoiding tobacco use and heavy alcohol consumption, and being sure to stay active can all help extend the results of your ACDF surgery.
Why Choose Princeton Neurological Surgery for Your ACDF Procedure?
Founded by Dr. John Lipani, a board-certified neurological surgeon, Princeton Neurological Surgery is a practice dedicated to helping people live their best lives. Utilizing advanced technologies, focusing on minimally and non-invasive treatment therapies, and offering a comprehensive range of services, our practice helps people find lasting comfort and relief.
We are fully committed to each patient we see and stay actively involved in every step of the planning, performing, and recovery process to help ensure optimal comfort. If you have been considering ACDF surgery, get in touch for a consultation with Dr. Lipani to learn more about your options.
“Dr. Lipani is the finest neurosurgeon! Compassionate, Caring, Down to Earth with his professionalism; he is the best! My son Alan, had an L-4/ L/5 Spine Fusion, 7.5 hour surgery and I can not thank the “Great Doctor”/Surgeon for his dedication, kindness and caring.” – Alan B.
“The Doctor outstanding in every way possible. Explaining every detail and taking his time to do so. Amazing for a surgeon to be so informing of the procedure to me and my wife. After the surgery he came out and explained everything to me. My wife is doing great after the cervical spine fusion, moving her arm in ways she hasn’t in years and getting her feeling back in her fingers” – Anthony R.
“Dr. Lipani and his staff are excellent. Dr. Lipani was very thorough. He explained what needed to be treated and why. He has terrific bedside manners. He answered all my questions patiently. Did not rush me at any time. I recommended him to one of my friends and she was extremely happy with him too.” – Poornima S.
What is recovery like from Anterior Cervical Discectomy and Fusion?
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 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 a multilevel disease where you don’t want to fuse a series of vertebrae together.
Risks Of Anterior Cervical Discectomy and Fusion 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
Will I have Activity Restrictions after Anterior Cervical Discectomy and Fusion?
You can expect to have certain activity restrictions in place while you recover from your Anterior Cervical Discectomy and Fusion surgery. The purpose of these restrictions is to enable the body to heal optimally, which means giving the bone graft time to integrate fully. You may be advised to wear a neck brace for a short time to limit the range of motion in your neck. You'll likely be instructed to avoid lifting objects that weigh more than 10 pounds. That said, you will be encouraged to walk every day beginning the day of or the day after your surgery. Walking supports circulation through the surgical site and can boost tissue recovery.
When Can I Drive After My Anterior Cervical Discectomy and Fusion Surgery?
You may start driving once you're no longer taking narcotic painkillers. It's also important that you make sure you can comfortably and safely perform all of the normal maneuvers needed, such as checking your blind spots and moving your foot from pedal to pedal. These actions may be more difficult if you're wearing a neck brace. For safety's sake, it may be wise to postpone any unnecessary errands or to have someone who can help you with tasks that would require you to drive.
Will I be in A Lot of Pain While I Recover from Anterior Cervical Discectomy and Fusion?
Your natural pain tolerance will be the primary factor that influences your comfort level after your neck surgery. It's normal to need prescription pain medication for two or more days. Some people need to continue using prescription-strength painkillers for up to two weeks. This is not to say you'll be in intolerable pain, but that you may feel varying degrees of soreness and ache while your neck recovers.
Will I Need Physical Therapy after Anterior Cervical Discectomy and Fusion?
Many orthopedic and spinal procedures require follow-up care from a licensed physical therapist. This is not the case with Anterior Cervical Discectomy and Fusion. You will be advised to walk every day, beginning in your immediate post-operative period. The purpose of taking several short walks a day is to ensure that you maintain efficient circulation. This facilitates optimal recovery and also works to prevent the development of blood clots in the legs. You may increase your walking as you feel more comfortable. That said, physical therapy and other targeted neck exercises should be avoided so as not to disturb the cervical spine as it heals.
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 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.