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Introduction
Procedure
Risks
Alternative Treatments
The cervical spine is comprised of vertebral bodies (also known as vertebrae) that are separated by soft intervertebral discs, which act to cushion the spine, allow mobility, and provide stability.
Anterior cervical discectomy and fusion (also known as ACDF) treats abnormalities in the cervical spine that arise from compression of the spinal cord and/or nerves due to instability of the spinal column, bone spur formation due to aging, or herniation (protrusion) of an intervertebral disc (as illustrated in the figure below).
In this procedure one or more discs are removed, followed by immobilization of the adjacent vertebral levels through placement of metal screws and plates. A graft material is generally placed between the vertebral levels (in the space previously occupied by the removed disc) in order to provide a conduit for bony fusion and to prevent collapse of the vertebrae. The graft may be made from synthetic materials, patient’s own bone, cadaveric donors, or a combination of these sources.
Over time, the vertebrae and graft will fuse together, leading to immobility and stabilization of the spine. The risk of non-fusion exists in every case despite good surgical technique, and this risk is increased with a history of tobacco use, certain medications (such as steroid or chemotherapy), malnutrition, and chronic illness.
After induction of general anesthesia, an incision is made in the front of the neck.
A thin muscle layer (platysma muscle) under the skin is opened.
The neck tissue is dissected down to the level of the spine at which point retractors (1 in figure below) are placed to keep the dissected tissue out of the way and to reveal the vertebrae (2 in figure below) and the disc (3 in figure below).
The tissue that is compressing the nerve root and/or the spinal cord is removed through a discectomy.
A graft material (1 in figure below) is placed in the cavity created by the discectomy.
Metal (titanium) plate and screws are then fastened to the vertebrae above and below the graft to stabilize it.
The retractors are removed and the incision is closed prior to the termination of the operation.
Due to advances in medicine and technology, surgical procedures are generally considered to be safe, and a great majority of patients who undergo surgery will not experience any complications. However, there are certain risks involved in any procedure which are important to be aware of in order to make an informed treatment decision.
Risks Specific to this Procedure: The risks associated with this surgery include, but are not limited to, damage to spinal cord or nerve roots leading to increased pain or other neurologic problems, loss of bowel/bladder function, sexual dysfunction, weakness or paralysis, numbness, cerebrospinal fluid leakage requiring placement of lumbar drain, need for further surgery, spinal instability at adjacent levels or non-fusion of the fused levels leading to need for future surgery or treatment, damage to the esophagus or trachea, laceration or damage to major blood vessels in the neck, swallowing difficulty, and transient or permanently hoarse voice.
Infection: Invasion of tissue by bacteria or other germs occurs to some degree whenever a cut, incision or puncture is made. In most instances, through the natural defense mechanisms of the body, healing of the affected area occurs without difficulty. In some instances antibiotic medicines are prescribed and at times additional surgical measures may be necessary to combat infection.
Hemorrhage: The cutting of blood vessels causes bleeding and this occurs in every surgical incision. This bleeding is usually controlled without difficulty. At times, blood transfusions are required to replace blood loss. If blood transfusions are given, there are additional risks of liver inflammation, hepatitis, and the possibility of receiving Acquired Immune Deficiency Syndrome (AIDS). There is no absolutely reliable way to predict these unwanted reactions, some of which may be quite serious and even lead to death.
Drug Reactions: Unexpected allergies, lack of proper response to medications or illness caused by the prescribed drugs are possibilities. It is important for you to inform your physician and your anesthesiologist or certified registered nurse anesthetist of any problem you or your family have had with reactions to drugs and which medications you have taken in the past six months, including over-the-counter drugs, especially aspirin.
Anesthesia Reactions: There may be unusual or unexpected responses to the gases, drugs or methods used to anesthetize you which can lead to difficulties with lung, heart or nerve function. Eating or drinking before anesthesia increases the risks of vomiting which may cause significant complications. Inform your anesthesiologist or certified registered nurse anesthetist of problems you and your family have had with anesthesia.
Blood Vessel Inflammation and Clotting: It is impossible to predict the occurrence of blood vessel inflammation and clotting problems. If blood clots form, they can move from where they formed to other areas of the body and cause injury.
Injury to Other Organs: Because of the closeness of other organs to the area being operated on, there may be injury to other organs. The stress of surgery or the procedure may also harm other organ systems of the body.
The alternative management modalities for this procedure are physical therapy, pain management using medications or injections, certain alternative medicine therapies (acupuncture), possibly other surgical procedures, and expectant management with no treatment at all. If the decision is made to not have this procedure, there may be associated risks which need to be discussed with a physician.
