Anterior Cervical Discectomy

What is Anterior Cervical Discectomy?

Anterior cervical discectomy and fusion (ACDF) is one of the most common neck surgeries performed.

The cervical spine is the portion of the spine located in the neck. A discectomy is a procedure that removes a damaged, arthritic or herniated disc. Discectomy means “removing the disc”. Therefore, an anterior cervical discectomy is a procedure that removes a damaged disc from the neck, using a surgical approach that starts at the front of the neck. Approaching the cervical spine through the front is minimally invasive and does not disrupt any muscles or blood vessels. This approach allows your doctor to avoid disturbing the muscles in the back of your neck.

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An anterior cervical fusion is done to take pressure off of the nerves and/or the spinal cord that is being compressed. In the case of spinal cord compression, the purpose of surgery is to stabilize the condition as the cord has often already undergone permanent damage. In the case of nerve compression the purpose of surgery is to decrease arm and neck pain and improve quality of life.

An anterior cervical discectomy is often performed along with a procedure called a spinal fusion to help stabilize the spine. Depending on your particular symptoms, one disc (single-level) or more (multi-level) may removed and fused.

After the disc is removed, to prevent the vertebrae from collapsing and rubbing together, a spacer is place between the bones. The vertebrae are fixed in place with metal plates and screws. This is called instrumentation. Following surgery, the body begins its healing process and new bone cells grow around the graft. After three to six months, the bone graft should join the two vertebrae together to form one solid piece of bone.

Fusing the spine does by definition reduce the amount of motion in the spine. However, this reduction is negligible particularly when only one or two levels are being fused. Interestingly, clinical outcome studies show that when a fusion involves two or fewer levels, patients do not subjectively feel as if they have lost motion. In fact, since the surgery often reduces neck and arm pain many patients feel as if they have increased mobility after surgery.

Your doctor will likely discuss motion-preserving artificial disc replacements as an alternative to fusion. Similar to knee replacement, the artificial disc is inserted into the damaged joint space and preserves motion. You may or may not be a candidate for disc replacement surgery. There are pros and cons for both fusion and disc replacement surgery.

Who Qualifies?

The most common reason to have this surgery is to relieve severe pain caused by one or more pinched spinal nerves or a compressed spinal cord. A pinched nerve can often lead to neck, shoulder blade, or arm pain (radiculopathy). A compressed spinal cord can lead to difficulties with fine motor skills, balance, and weakness (myelopathy).

Nonsurgical options depend on whether you have a compressed spinal cord or a pinched nerve. Nonsurgical options for a compressed spinal cord are limited and involve the use of a soft collar or epidural steroid injections. Nonsurgical options for a pinched nerve are extensive and include physical therapy, medications, acupuncture, chiropractic care, as well as injections. A pinched nerve can either be treated by taking the inflammation off the nerve so the nerve learns to live in a small space or by making more space for the nerve which is surgery. An epidural steroid injection involves placing steroid, a very strong anti-inflammatory around the nerve to break the cycle of inflammation. It is unusual for patients to proceed to surgery without exhausting all conservative options.

An anterior cervical fusion is done to take pressure off of the nerves and/or the spinal cord that is being compressed. In the case of spinal cord compression, the purpose of surgery is to stabilize the condition as the cord has often already undergone permanent damage. In the case of nerve compression the purpose of surgery is to decrease arm and neck pain and improve quality of life.

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