Anterior Cervical Discectomy and Fusion (ACDF)
When a patient is suffering from pain and numbness caused by a herniated disc in the neck, Dr. Greenwald may perform the Anterior Cervical Discectomy and Fusion (ACDF) to alleviate the pain and discomfort. This procedure is designed to remove a herniated disc or bone compression, and to decompress the spinal cord, and then to replace the removed disc with a special bone graft. The ACDF surgery is an effective procedure, when performed by an experienced surgeon, and can significantly reduce the patient’s discomfort and improve quality of life after the patient has fully recovered. However, in order for Anterior Cervical Discectomy and Fusion to be effective, great care must be taken during the procedure to fully remove the herniated disc and carefully check the nerves in the affected area to ensure full decompression.
If your doctor has suggested Anterior Cervical Discectomy and Fusion surgery to address a herniated disc, please call our Mountain View or Redwood City practices at 650-968-4747 to set up your consultation with Dr. Greenwald.
What is Anterior Cervical Discectomy and Fusion?
Within our spinal column, we have discs that separate and cushion our vertebrae. These discs are an important part of spine health, as they provide shock absorption. To do their job effectively, these discs are filled with a fluid, gel-like substance, which is surrounded by a tough outside membrane (much like a jelly donut).
When a disc becomes herniated, the soft gel inside the disc pushed outward, against the hard membrane, creating a bulge. This bulge can remain enclosed by the membrane, or the membrane may even rupture, allowing some of the gel to leak out. The distortion in the disc’s shape will then press against the spinal cord and the surrounding nerves, which creates the characteristic numbness and pain associated with a herniated disc. Often these discs can become calcified and bonelike (these are often referred to as “spurs”), causing the same symptoms.
Fortunately, although many individuals will experience a herniated disc in their lifetime, most will not need to undergo surgery. In many cases, rest and physical therapy can address the problem because the injury hasn’t reached a critical point. However, when the symptoms of a herniated disc show no improvement, an Anterior Cervical Discectomy and Fusion can be performed to remove the damaged disc and replace it with a bone graft.
How is Anterior Cervical Discectomy and Fusion Performed?
When you visit Dr. Greenwald for your ACDF consultation, he will meticulously review your medical records and imaging tests, and order additional tests if necessary. If you are a candidate for Anterior Cervical Discectomy and Fusion, we will schedule your surgery as soon as possible, and provide you with all of the necessary pre-operative instructions. For example, depending on your medical history, you may be asked to stop taking some of your medications before surgery.
Anterior Cervical Discectomy and Fusion is performed under general anesthesia, so the patient does not experience any pain or discomfort. To perform the procedure, Dr. Greenwald will make a small incision in the front of the neck, usually in a skin crease, for cosmetic purposes. Retraction of important structures, such as muscles, ligaments, esophagus and trachea, is then performed to reach the herniated disc. Usually, no muscles need to be cut, as there is a natural plane to the disc.
In that sense, there are several good reasons why this surgery is performed through an incision in the front of the neck, rather than the back. First, this approach to the disc eliminates the need to manipulate the spinal cord and the surrounding nerves, which are located behind the disc. Second, in many cases the incision can be made in one of the neck creases, which significantly reduces the visibility of the final scar.
Once the disc has been reached, Dr. Greenwald will use microscopic technique (and years of experience) and will also utilize special drills, using operating loops and or surgical microscope, to remove the disc.
After the disc has been removed, Dr. Greenwald will perform microdissection to decompress the surrounding nerves. This may involve removing extra bone fragments on the vertebrae, to ensure that the nerves have sufficient room. Part of this process also involves visualizing the spinal cord and surrounding nerves, as this helps ensure the success of microdissection and decompression.
Thereafter, the surface of the vertebrae must be prepared to accept the bone graft and to ensure proper fusion. This means that the surface area of the affected vertebrae must be prepared using an experienced drilling technique to achieve the proper surface and spacing to hold the bone graft and ensure optimal fusion. Dr. Greenwald pays special attention to this process as the proper fitting of the graft improves a patient’s comfort after the procedure.
Once the space between the vertebrae has been prepared, the next step in Anterior Cervical Discectomy and Fusion is to implant a bone graft between the two vertebrae. The graft is often obtained from extremely reliable bone banks, and allows for fast healing and virtually no chance of tissue rejection. Its function is to fill in the space of the removed disc, so that normal anatomy of the vertebrae can be maintained. (Eventually, the two vertebrae and the bone graft will fuse together.)
When the bone graft has been situated into its place, a small anterior metal plate is then attached to the vertebrae to improve stability and aid in the fusion process. The titanium plate that Dr. Greenwald uses was partially designed by him, to ensure proper compression and fusion. It is held in place with small screws, and has been shown to speed up the healing process after Anterior Cervical Discectomy and Fusion.
Recovery from Anterior Cervical Discectomy and Fusion
After the ACDF surgery has been completed, it’s important to follow all aftercare instructions provided by Dr. Greenwald and his staff. It is rare to need corrective surgery because of non-fusion, under Dr. Greenwald’s expert care.
The first three to six weeks after your surgery are an important time. Stability is achieved through the use of cervical collar that is either soft or hard (depending on how many vertebrae levels were done). This collar is important to maintain alignment.
Mild exercise and low impact physical activity may be initiated two to three weeks after the procedure. Most patients are up walking briskly in a few days, and may even return to work in a few days with the collar on, but obviously avoiding heavy lifting.
Patients usually need to sleep in the collar for the first two to three weeks.
After the six week post operative period, a bending X-ray will be performed, and after review of these films, the collar is almost always discontinued. This typically takes place during the second post operative appointment.
Although the collar may be discontinued, radiographic evidence of full fusion typically shows 6 months after Anterior Cervical Discectomy and Fusion surgery. Most normal activities can be resumed at approximately 3 months.
Benefits of Anterior Cervical Discectomy and Fusion
Anterior Cervical Discectomy and Fusion is very effective for eliminating the pain and numbness associated with a herniated disc. This procedure provides long term results, and most patients are able to return to their normal activities in three to six months.
Side Effects of Anterior Cervical Discectomy and Fusion
One of the most common concerns with patients who are preparing for ACDF surgery is whether they’ll have the same range of motion. This aspect is usually not perceptible for any patient who has less than 3 levels done. Ninety percent of the movement in the neck is at the top of the neck, so there is no perceptible loss in range of motion. However, Dr. Greenwald has found that for most patients who need to repair only one or two (or even three) herniated disc, the range of motion largely remains the same.
However, one important note must be made for patients who consume tobacco, as smoking or chewing tobacco negatively affects the healing process. Firstly, tobacco slows bone growth, thus making it more difficult for bone fusion to occur. Secondly, it shrinks blood vessels, making it harder for the treatment site to receive oxygen and vital nutrients.
Therefore, if you are a smoker and are considering Anterior Cervical Discectomy and Fusion, it is highly advisable to quit all tobacco products several weeks before the procedure, and to abstain from tobacco for at least several months after surgery, to ensure proper healing. (Of course, quitting smoking permanently has a range of other benefits to your health, and should be considered regardless of whether you get ACDF surgery.)
Your Anterior Cervical Discectomy and Fusion Consultation
A herniated disc often brings with it lots of physical pain and discomfort, as well as stress and anxiety. Having worked with hundreds of patients over the years, Dr. Greenwald understands this very well and makes it his priority to provide care that is compassionate and focused on the physical and psychological needs of his patients. Dr. Greenwald’s goal is to give you the best surgical outcome, while helping you deal with the anxiety and sense of helplessness that can accompany the neurological problems associated with a herniated disc.
If your primary care physician has suggested you consider Anterior Cervical Discectomy and Fusion surgery, please make an appointment with Dr. Greenwald for a consultation. Simply give us a call at 650-968-4747, or click “Request Appointment” below!