Anterior cervical discectomy with fusion, or ACDF, is a surgery designed to relieve spinal cord or nerve root pressure in the neck by removing all or part of a damaged disc. This procedure starts with a one- to two-inch incision in the front of the neck. The thin layer of platysma muscle that lies under the skin is cut and moved aside. The pre-vertebral fascia, a thin layer of fibrous tissue that encases the spine, is dissected away, exposing the intervertebral disc.
The surgeon confirms that the correct disc has been located by inserting a needle into the disc space under X-ray guidance. An incision is made in the outer coating of the disc, called the annulus fibrosus, and the soft inner core of the disc, called the nucleus pulposus, is removed. Most of the damaged disc is extracted, but a small portion may be left intact.
Next, the surgeon examines the posterior longitudinal ligament. The ligament may be removed to access the spinal canal so the surgeon can remove any bone spurs or disc material that may have extruded through the ligament.
Next, the anterior cervical fusion is performed, in which a bone graft or a cage is inserted into the space where the disc used to be.
This procedure serves to prevent the disc space from collapsing and allows the bone to grow together to set up a bony bridge, or fusion, between the upper and lower vertebrae. A small metal plate is typically affixed to the front of the upper and lower vertebrae to provide stability while the bone fusion heals together, a process that can take up to 18 months.
Patients typically can go home on the same day as the surgery, or after one overnight stay in the hospital.