A cervical disc herniation can be removed through the front of the neck (anterior approach) to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness and tingling.
This procedure is called an anterior cervical discectomy and allows the offending disc to be surgically removed. A discectomy is a form of surgical decompression, so the procedure may also be called an anterior cervical decompression.
A fusion surgery is almost always done at the same time as the discectomy in order to stabilize the cervical segment. Together, the combined surgery is commonly referred to as an ACDF surgery, which stands for Anterior Cervical Discectomy and Fusion.
While this surgery is most commonly done to treat a symptomatic cervical herniated disc, it may also be done for cervical degenerative disc disease. It may also be done for more than one level of the cervical spine.
The anterior approach of this surgery, which means that the surgery is done through the front of the neck as opposed to the back of the neck, has several typical advantages.
After a skin incision is made in the front of the neck, only one thin vestigial muscle needs to be cut, after which anatomic planes can be followed right down to the spine. The limited amount of muscle division or dissection helps to limit postoperative pain following the spine surgery.
While there are a number of potential risks and complications with ACDF surgery, the main postoperative problem most patients face is difficulty swallowing for 2 to 5 days due to retraction of the esophagus during the surgery.
The general procedure for an anterior cervical discectomy and fusion – or ACDF – surgery includes the following steps:
An anterior cervical fusion is almost always done as part of a cervical discectomy. The insertion of a bone graft into the evacuated disc space serves to prevent disc space collapse and promote a growing together of the two vertebrae into a single unit, with this ‘fusion’ preventing local deformity (kyphosis) and serving to maintain adequate room for the nerve roots and spinal cord.
Patients typically go home the same day as the anterior cervical discectomy and fusion or after one night in the hospital. Most patients recover within about 4 to 6 weeks, although it may take up to 18 months for the fusion to fully set up. Patients should discuss relevant activity restrictions and rehabilitation with their surgeon.
As with any surgery, there are a number of possible risks and complications of anterior cervical discectomy surgery.
The rate of occurrence of potential risks and complications is highly variable and dependent mainly on a combination of:
For an ACDF surgery, the main potential risks and complications that tend to occur include:
Also, the small nerve that supplies innervation to the vocal cords (recurrent laryngeal nerve) will sometimes not function for several months after neck surgery because of retraction during the procedure. This complication can cause temporary hoarseness. Retraction of the esophagus can also produce difficulty with swallowing, which usually resolves within days but can last weeks to months. Rarely, it can result in permanent difficulty swallowing.
There is little chance of a recurrent disc herniation because most of the disc is removed with this type of surgery.
Patients are advised to discuss the potential risks and complications with their surgeon prior to having ACDF surgery.