What Is Anterior Cervical Decompression And Fusion Surgery (ACDF)?
ACDF is a spinal procedure that may be performed when non-surgical interventions have failed to achieve lasting pain relief in the instance of cervical radiculopathy. The objective of this surgery is to alleviate pressure on the spinal cord that has originated with bone spurs, herniated disc, or other degenerative disc disease.
Am I A Candidate For Anterior Cervical Decompression And Fusion Surgery?
Patients for whom conservative modalities such as physical therapy and medication have not produced the desired amount of symptom relief may be good candidates for ACDF surgery. In addition to a thorough history of the neck injury itself, we will also complete a detailed medical history to confirm the patient is insufficient health to undergo neck surgery and its recovery period. Some patients may need to stop smoking or modify certain medications in order for ACDF to be considered a viable treatment option.
There are two major parts of the Anterior Cervical Decompression and Fusion Surgery:
First, an incision is made in the lower part of the front of the neck. Underlying muscle tissue, trachea, esophagus, and carotid artery are maneuvered so the surgeon has direct access to the front of the cervical spine (the anterior aspect).
Retractors are then inserted to hold delicate structures in place while the surgeon observes the spinal segment using surgical loupes or an operating microscope.
Fluoroscopy or x-ray imaging is used to confirm the level or levels of the intervertebral spaces that need to be decompressed. Decompression is achieved by removing bone and soft tissue that are pressing down on the nerve root or roots. Space is then reconstructed to support the cervical spine.
Normal loads of the cervical spine may be reinstating with grafting that spans the intervertebral space. This consists of a combination of bone from the bone bank and local bone from the area of the spinal decompression.
In a majority of cases, Dr. Todd Albert does not take a bone graft from the patient’s iliac crest (hip area) meaning you will not have a separate incision. The second component of the fusion is the instrumentation. This is a plate and screws that are then placed anterior to the vertebrae.
ACDF Surgery Risks
Risks of Anterior Cervical Decompression and Fusion Surgery include:
- Bleeding or hematoma formation at the surgical site
- Damage to the vertebral or carotid artery
- Chronic hoarseness caused by damage to the recurrent laryngeal nerve
- Difficult swallowing caused by damage to the superior laryngeal nerve
- Damage to the trachea or esophagus
- Cerebrospinal fluid leak or accumulation of spinal fluid beneath the incision
- Mechanical complications of titanium fixtures or grafting material
- Inadequate fusion, causing ongoing pain
- Unresolved damage to the nerve root or spinal cord, causing ongoing pain or other symptoms
Overall, most patients who undergo Anterior Cervical Decompression and Fusion Surgery enjoy significant improvement. Results are maximized when surgery is performed before the spinal cord has been severely injured. ACDF surgery has been shown to halt the progression of spinal disease by removing the source of nerve compression and spinal damage. When consulting with patients, a surgeon estimates prognosis based on the severity of the existing compression.
Is Fusion Surgery Painful?
It is important to keep in mind that pain is a very subjective experience and one’s reaction to surgery is affected by a variety of factors. After ACDF surgery, the most common concerns we hear from patients are a sore throat (similar to after getting a tonsillectomy) and discomfort around their scapula (or shoulder blade). Both of these tend to resolve prior to the first post-operative appointment at 2-3 weeks after surgery.
It is not uncommon for patients to experience “reminder” pain after surgery. This is when a patient begins to experience the same symptoms as they had before surgery. While this is common in recovery from spine surgery we understand that this can be very concerning to our patients. We encourage you to call the office with any concerns you may have after surgery.
What Should I Avoid Before ACDF Surgery?
We ask that you refrain from taking any nonsteroidal anti-inflammatory medicines 10 days before and 10 weeks after surgery such as:
- Any herbal supplements
- Vitamin E
- Vitamin K
- Fish Oil
If you have a physician who recommends that you do not stop Aspirin prior to surgery please be sure to discuss this with our office. You should also discontinue all exposure to nicotine, as well as nicotine-containing products, two weeks before and at least 6 weeks after your surgery.
Dr. Albert performed the following surgery: anterior cervical discectomy and fusion, C3- C6 with instrumentation, posterior cervical laminectomy, C3-C6 and fusion with instrumentation and bone graft.
One could describe Dr. Todd J. Albert as a gentle giant, yet a doctor and a surgeon who is very proficient and accomplished in his work. Confident with sound judgment and compassionate about his work, one could say Dr. Albert is a genius, an Amazing doctor, nothing but perfection, a doctor with honor and integrity who takes much pride in his work. I continue to think of Dr. Todd J. Albert as a Superman in my life who took over for the rescue when I was drowning with spine problems with no hope and no answers, restoring my hope and giving me answers to all aspects of my spine condition.
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Anterior Cervical Decompression And Fusion Recovery
During the first 2-3 weeks after you have anterior cervical decompression and fusion surgery, your activity will be limited to walking. We encourage you to walk as much as you are comfortable. You may go up and down stairs, with the use of a railing, and you may also sleep in a normal bed. You will be limited to lifting 5 pounds for the first 2 weeks. After two weeks you will be able to resume low-impact cardiovascular activities and increase the amount of weight you are lifting. Within a reasonable amount of time, you will have very few restrictions on your activities. Please be sure to discuss any specific questions with us in the office.
The first visit is 2-3 weeks after surgery however if you have any questions or concerns please call the office. If we think we should see you in the office we will schedule an earlier appointment. Most patients do not have sutures that need to be removed after an Anterior Cervical Decompression and Fusion Surgery. There are internal sutures that will dissolve with time. There will also be steri-strips (white pieces of tape) over the incision that will either fall off or we will remove them on the office.
Please keep in mind that the recovery from surgery is quite subjective and is affected by various factors such as patient age, comorbid illnesses, the degree of the spinal cord or nerve impingement, the length of illness prior to surgery as well as the degree of disability prior to surgery to name a few.
Anterior Cervical Decompression And Fusion FAQs
How Long Will I Be Wearing A Soft Collar After This Procedure?
These procedures formerly involved external immobilization of the patient’s neck, however recent advances in the materials used to complement the fusion have made this mostly unnecessary. Still, a soft collar, and in rare instances a hard collar (also known as an Aspen or Miami J collar) will likely be part of your recovery.
Soft collars are used primarily for comfort, as they don’t provide rigid support. Soft cervical collars are typically worn between 2-4 weeks after surgery. The prescribed amount of time you will be wearing the collar will vary depending on the particulars of your situation and the varying factors that are taken into consideration.
How Long Will I Be Out Of Work After ACDF?
This is a challenging question to answer as it varies somewhat for each individual patient. You will not be able to lift more than 5-10 pounds for at least 2 to 3 weeks after surgery. To gauge that amount of weight, a gallon of milk weighs 8 pounds. If your work involves any lifting or manual labor it may be recommended that you refrain from returning to work for several weeks. If you have a sedentary desk job, you may be able to return to work in as little as a week after surgery.
How Soon After My Surgery Will I Be Able To Drive?
You can be a passenger in a car as soon as you feel up to it.
Many patients are able to return to driving short distances, such as to the neighborhood grocery store, in 2 to 3 weeks after their surgery. Know that some patients can drive sooner, while others need more time. You should not drive while you are wearing the soft collar, which is typically discontinued through a weaning process at the first post-operative appointment.
Will I Need Physical Therapy After ACDF?
Physical therapy is also subjective. We will provide isometric neck strengthening exercises that can be performed independently. If either you or Dr. Albert feel that an outpatient physical therapy program is needed and appropriate we will provide you with a prescription at the first post-operative appointment.
Will I Set Off Metal Detectors After Having ACDF Surgery?
The materials used for modern fusion are made of titanium. The instrumentation used for this procedure does not set off metal detectors.
Can I Have An MRI After Having ACDF Surgery?
You can have magnetic resonance imaging performed after you’ve had cervical fusion but please be sure to let the technician know that you have had an ACDF with instrumentation.
Schedule An ACDF Consultation Today!
For more information on ACDF surgery or to determine whether you are a candidate for the procedure, be sure to schedule a consultation with New York City Spine Surgeon Dr. Todd J. Albert. Call 212-606-1004 or go to our contact page to fill out an appointment request form. Our practice looks forward to serving you!