Anterior cervical discectomy and fusion (ACDF)
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.
The procedure is carried out via an anterolateral neck incision with surgical approach passing between the aerodigestive tract (trachea, esophagus, 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:
- 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
- metal (e.g. titanium or stainless steel)
Following this, a plate with screws that pass into the vertebral bodies above and below the operative segment is usually introduced to provide additional stabilization 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.
A common way to follow up ACDF is the lateral cervical radiograph to assess for prevertebral soft tissue swelling. A 2017 prospective study with 106 patients post-ACDF 4 measured the difference of the soft tissue thickness anterior to the midportion of C3 and C6 at immediate post-op, 2 weeks, 1 month, 6 months and 12 months after surgery against baseline:
- C3: significant difference up to 1 month; from third month the difference was not significant (i.e. back to the baseline)
- post-op: 5.10-6.56 mm
- 2 weeks: 2.61-4.07 mm
- 1 month: 1.12-2.68 mm
- C6: significant up to 6 months
- post-op: 4.01-5.47 mm
- 2 weeks: 2.72-4.18 mm
- 1 month: 1.78-3.24 mm
- 3 months: 0.98-2.44 mm
- 6 months: 0.40-1.86 mm
Although the procedure is generally safe a number of complications can be encountered including 3:
- intraoperative complications
- esophageal perforation
- damage to the carotid artery or internal jugular vein
- immediate postoperative complications
- delayed complications
- 1. Song KJ, Choi BY. Current concepts of anterior cervical discectomy and fusion: a review of literature. (2014) Asian spine journal. 8 (4): 531-9. doi:10.4184/asj.2014.8.4.531 - Pubmed
- 2. Edward C. Benzel. Spine Surgery 2-Vol Set. (2012) ISBN: 9781455723324
- 3. Petscavage-Thomas JM, Ha AS. Imaging Current Spine Hardware: Part 1, Cervical Spine and Fracture Fixation. (2014) American Journal of Roentgenology. 203 (2): 394-405. doi:10.2214/AJR.13.12216 - Pubmed
- 4. Kim SW, Jang C, Yang MH, Lee S, Yoo JH, Kwak YH, Hwang JH. The natural course of prevertebral soft tissue swelling after anterior cervical spine surgery: how long will it last?. (2017) The spine journal : official journal of the North American Spine Society. 17 (9): 1297-1309. doi:10.1016/j.spinee.2017.05.003 - Pubmed