Surgical Options

Anterior cervical discectomy and fusion

Anterior cervical discectomy and fusion, or ACDF, is a surgical procedure used to treat patients with a compressed nerve or spinal cord who do not improve with conservative care. If a patient has a compressed spinal cord and exhibits any symptoms, they will most likely need to undergo surgery regardless of their response to conservative care, since conservative care is unlikely to improve the symptoms.

The incision is made in the front of the neck, usually in a horizontal skin fold. After the incision, there is a natural plane toward the anterior spine, which makes access easy and is usually why most patients do not have a lot of postoperative pain. The surgeon removes the disc to allow access to the spinal cord and spinal nerves. Once the disc is removed, the surgeon frees the compressed nerve or spinal cord to provide relief.

Since there is no disc remaining, the surgeon replaces it with a spacer and secures the spacer with a plating system. The spacer can be cadaver bone, your own bone, PEEK plastic, or titanium cage. Titanium is compatible with MRI, CT, and x ray. The spacer is secured with a plate or similar device to add stability to the construct.

The procedure is a fusion and will cause the vertebral bodies above and below the disc to grow together in bony union. Some patients worry that fusion will cause more damage as they age, but the data remains early. The procedure is similar to anterior cervical disc replacement, since both remove pressure from the nerves, but ACDF fuses adjacent segments and does not allow motion. ACDF can be done at any number of cervical levels.

Anterior cervical disc replacement

Anterior cervical disc replacement, or ACDR, is a surgical procedure used to treat patients with a compressed nerve or spinal cord who do not improve with conservative care. The surgeon removes the disc and replaces it with a synthetic disc device that allows motion. The surgery is similar to ACDF, since both remove pressure from the nerves, but unlike ACDF, ACDR preserves motion. This can be done at one or two levels, but not three levels.

Patients may not be a disc replacement candidate if they have excessive neck pain or compression of the spinal cord. There are reports that excessive cervical motion after anterior cervical disc replacement can cause worsening of neck pain, even after surgery.

There is still significant controversy comparing anterior cervical fusion to disc replacement. Current studies support minimal difference at five to seven years in patients who undergo a one level fusion versus disc replacement. For two level constructs, the data suggests outcomes may be slightly better in the disc replacement group. Disc replacement is not approved for three level constructs. Patients presenting with only neck pain, and no arm pain or cord compression, would most likely benefit from a cervical fusion rather than disc replacement.

The disc replacement procedure is similar to cervical fusion in terms of length of surgery, complications, pain, and overall recovery. As with cervical fusion, patients are usually discharged home the same day and are back to most activity within a few weeks. Most patients request or consider cervical disc replacement because there is a risk of needing further surgery on the cervical spine. After cervical fusion, patients have a nine percent chance of more surgery on an adjacent level over their lifetime.

What to know after surgery

Do I go home the same day?

Most patients who undergo a one level or two level surgery go home the same day. If patients live too far away or live alone, we sometimes recommend an overnight stay. Patients who undergo a three level surgery usually stay overnight and go home the next day.

Wound care

The incision is usually one and a half inches long, placed horizontally in a skin fold of the neck to the left or right. The incision is closed with subcuticular sutures that dissolve and do not need to be removed. We place steri strips over the incision and then cover with a 2 by 2 inch gauze pad and adhesive. You can shower the day after surgery, but the shower should be quick. You can remove the adhesive and gauze pad on postoperative day two. Leave the steri strips on and your surgeon will remove them at your first postoperative visit.

Pain medications

No history of pain medications: If you have not taken pain medications in the past, you will be given a small dose that you take only if you need them. Try to use Tylenol or Motrin when possible. The sooner you stop taking narcotic pain medication, the better you will feel.

History of pain medications: If you have taken pain medications before surgery, we work with your pain management physician to cover your surgical pain. Once you recover from the surgical pain, usually two to four weeks, your pain management provider takes over.

Driving

Unless you do not feel well, you can begin driving 48 hours after surgery. If your surgeon does not think you should drive, they will tell you before you leave the hospital.

Work

Discuss with your surgeon before surgery. Depending on your occupation, some patients return to work within days after surgery. If your job requires physical labor, it may be six to twelve weeks before you can return to work.

Bathing and showers

The day after surgery you can shower. Shower as quickly as possible. Do not worry if the dressing is exposed to water. We do not recommend baths or hot tubs for the first four weeks after surgery.

Activity

Exercise

Walking is the only exercise recommended in the first four weeks after surgery. During your postoperative visits, discuss your exercise goals with your surgeon.

Sex

It is safe to start having sex in the days after surgery.

Postoperative visits

You will see your surgeon after surgery in seven days, one month, three months, and then one year. You should have x rays at each visit.