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ACDF

The goal of an anterior cervical decompression and fusion (ACDF) surgical procedure is to treat severe nerve root or spinal cord compression by decompressing the nerve roots of the cervical spine in order to stabilize the corresponding vertebrae. This procedure is typically utilized when other non-surgical treatments have consistently failed.

This procedure uses an anterior (from the front of the neck) approach of the spine at the affected levels. First, the intervertebral disc(s) that is/are causing the problem is removed. This is commonly referred to as a discectomy. Then the empty space is filled with bone graft. This allows a fusion to occur. A fusion occurs when the bones grow together creating a bond between the two vertebrae. A plate is then positioned over the bone graft to provide immediate, temporary stability for the anterior cervical spine while the bone graft (s) try to fuse. The plate is attached to the affected levels using screws. Plates may potentially be used in patients who have received a diagnosis from their doctor of degenerative disc disease, trauma, tumors, deformity, pseudoarthrosis and/or a failed
previous fusion.

There are potential risks associated with the use of these devices some of which include: disassembly, bending, and/or breakage of any or all of the components, pressure on the skin from the plate which could cause skin penetration, irritation, and/or pain, tissue or nerve damage, scar formation, interference with imaging of the area, and other risks.

This surgery is commonly performed for radiculopathy causing persistent arm pain with weakness and numbness or myelopathy causing weakness of upper and/or lower extremities. Depending on what's done surgery may take one to four hours.

Success rate of this surgery is usually 90% in relieving patient's arm pain. Weakness and numbness may improve even though at times this is unpredictable especially if there is irreversible nerve damage or spinal cord damage present prior to surgery.

Patients are usually sent home in one to three days. Titanium plate is used in addition to structural allograft bone available from various spine implant companies. Patients are asked to wear neck collar from 6 weeks to 3 months depending on what's done.

There is not much pain associated with this surgery. A transverse incision is made on the left side of the neck and the surgeon works between esophagus/trachea complex on one side and carotid artery on the other side. These structures are carefully protected using special retractors during the surgery. Power drill is used to shape the interspace and decompression of either the nerve root or spinal cord is performed and after that a bone graft of appropriate dimension is chosen and inserted into the interspace and metallic plate is applied on top of it using tiny screws.

Blood loss is minimal unless corpectomy (removal of entire vertebra) is performed. Wound infection is rare. Sore throat and swallowing difficulty is expected but this resolves in a week or two even though when extensive dissection is necessary such as revision cases swallowing difficulty with certain kind of food may become permanent. Hoarseness of voice due to injury to the recurrent laryngeal nerve of the voice box can occur but the incidence is greatly reduced by approaching the spine from the left side as opposed to from the right side. The incidence from the left side is less than 1%. Depending on the situation such as nerve injury or paralysis can occur but these are quite rare unless the spinal cord is so compromised to begin with such as is the case in quadraparetic patients with spinal cord myelomalacia and OPLL( ossified posterior longitudinal ligament). In the latter case risk of paralysis can be substantial and intraoperative spinal cord monitoring is used for the surgery. Other potential but rare complications of the surgery include injury to esophagus, trachea, and vertebral artery.

In general cervical spine surgery is better tolerated and long term results are better than lumbar spine surgery. Conservative care such as physical therapy and cervical epidural steroid injections are encouraged prior to surgery except in cases of myelopathy with spinal cord compromise and in the latter situation only surgery may help.

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