Anterior cervical discectomy and fusion (ACDF)
Updates to Article Attributes
Anterior cervical discectomy and fusion (ACDF) is a commonly performed spinal fusion procedure for the decompression of the cervical cord due to disc protrusions and posteriorly projecting osteophytes.
Technique
The procedure is carried out via an anterolateral neck incision with surgical approach passing between the aerodigestive tract (trachea, oesophagus, pharyngeal muscles) medially and the carotid neurovascular bundle (carotid artery, internal jugular vein, vagus nerve) laterally 2.
The intervertebral disc is then resected along with the fibrocartilage covering the adjacent vertebral endplates (to allow for eventual osseous fusion). It is possible to reach back to the posterior longitudinal ligament, removing osteophytes and disc protrusion as well and extending laterally to decompress the neural exit foramina 1,2.
Once decompression has taken place an interbody spacer (or "cage") of some kind is introduced. This can be in the form of 1,3:
- bone
- autogenous bone graft (e.g. from the anterior iliac crest of the patient harvested at the same time as the fusion is performed)
- allogenic bone graft (e.g. from cadaveric iliac bone or fibula)
- animal allogenic bone graft (e.g. bovine or calf)
- synthetic usually packed with cancellous autobone, demineralized bone matrix or ceramics
- plastic
- metal (e.g. titanium or stainless steel)
- ceramic
Following this, a plate with screws that pass into the vertebral bodies above and below the operative segment is usually introduced to provide additional stabilisation 1.
Newer devices combine screw fixation and interbody spaced into the one device, fitting entirely within the interbody space without the added bulk of the anterior plate 1.
Follow Up-up
A common way to follow up ACDF is the lateral cervical X-Rayradiograph to lookassess for prevertebral soft tissue swelling. A prospective 2017 study with 106 patients post ACDF-ACDF 4 followed the difference of the soft tissue thickness anterior to the midportion of C3 and C6 up to 12 months after surgery against baseline:
- C3
- Significant: significant difference up to 1 month. After; after the3rdthird month the difference was not significant(back(i.e. back to the baseline)-
Postpost-op: 5.10~ 6-6.56 mm - 2 weeks: 2.61
~4-4.07 mm - 1 month: 1.12
~ 2-2.68 mm
-
- C6
- Significant: significant up to 6 months-
Postpost-op: 4.01~ 5-5.47 mm - 2 weeks: 2.72
~ 4-4.18 mm - 1 month: 1.78
~ 3-3.24 mm - 3 months: 0.98
~ 2-2.44 mm - 6 months: 0.40
~ 1-1.86 mm
-
Complications
Although the procedure is generally safe a number of complications can be encountered including 3:
- intraoperative complications
- oesophageal perforation
- damage to the carotid artery or internal jugular vein
- immediate postoperative complications
- dysphagia due to plate and screws
- hoarse voice due to damage to the recurrent laryngeal nerve
- delayed complications
-</ul><p>Following this, a plate with screws that pass into the vertebral bodies above and below the operative segment is usually introduced to provide additional stabilisation <sup>1</sup>.</p><p>Newer devices combine screw fixation and interbody spaced into the one device, fitting entirely within the interbody space without the added bulk of the anterior plate <sup>1</sup>. </p><h4>Follow Up</h4><p>A common way to follow up ACDF is the lateral cervical X-Ray to look for prevertebral soft tissue swelling. A prospective study with 106 patients post ACDF<sup>4</sup> followed the difference of the soft tissue thickness anterior to the midportion of C3 and C6 up to 12 months after surgery against baseline:</p><ul>-<li>C3 - Significant difference up to 1 month. After the 3rd month the difference was not significant (back to the baseline)<ul>-<li>Post-op: 5.10 ~ 6.56 mm</li>-<li>2 weeks: 2.61 ~4.07 mm</li>-<li>1 month: 1.12 ~ 2.68 mm</li>- +</ul><p>Following this, a plate with screws that pass into the vertebral bodies above and below the operative segment is usually introduced to provide additional stabilisation <sup>1</sup>.</p><p>Newer devices combine screw fixation and interbody spaced into the one device, fitting entirely within the interbody space without the added bulk of the anterior plate <sup>1</sup>. </p><h4>Follow-up</h4><p>A common way to follow up ACDF is the lateral cervical radiograph to assess for prevertebral soft tissue swelling. A prospective 2017 study with 106 patients post-ACDF <sup>4</sup> followed the difference of the soft tissue thickness anterior to the midportion of C3 and C6 up to 12 months after surgery against baseline:</p><ul>
- +<li>C3: significant difference up to 1 month; after the third month the difference was not significant (i.e. back to the baseline)<ul>
- +<li>post-op: 5.10-6.56 mm</li>
- +<li>2 weeks: 2.61-4.07 mm</li>
- +<li>1 month: 1.12-2.68 mm</li>
-<li>C6 - Significant up to 6 months<ul>-<li>Post-op: 4.01 ~ 5.47 mm</li>-<li>2 weeks: 2.72 ~ 4.18 mm</li>-<li>1 month: 1.78 ~ 3.24 mm</li>-<li>3 months: 0.98 ~ 2.44 mm</li>-<li>6 months: 0.40 ~ 1.86 mm</li>- +<li>C6: significant up to 6 months<ul>
- +<li>post-op: 4.01-5.47 mm</li>
- +<li>2 weeks: 2.72-4.18 mm</li>
- +<li>1 month: 1.78-3.24 mm</li>
- +<li>3 months: 0.98-2.44 mm</li>
- +<li>6 months: 0.40-1.86 mm</li>
Unable to process the form. Check for errors and try again.