Anterior Cervical Discectomy & Fusion (ACF)
Anterior = From the front
Cervical = Neck, involving one or more of the top 7 intervertebral discs.
Fusion = Setting up conditions for added bone to grow to existing bone.
PEEK (polyether-etherketone) = Synthetic polymer used to promote fusion.
What Are Some Of The Reasons I Might Need An ACF?
Cervical radiculopathy (arm or hand pain) is one of the most common reasons for cervical surgery. The nerve distribution may involve one or more of the following: neck, shoulders, arms, hands.
Symptoms might include neck pain and possible pain, numbness, tingling, or weakness in one or both arms and/or hands.
Some of the conditions that might require an Anterior Cervical Fusion:
- You have a herniated disc.
- A fusion may be considered when your diagnosis is degenerative disc disease, internal disc disruption, or unstable spine.
- An unstable spinal column allows one vertebral body to slip forward or backward above or below adjacent vertebra. This movement narrows the foramen, putting pressure on the nerve roots. If the spine is unstable, a fusion will promote stability and problems with curvature of the spine may be corrected.
- Normal aging or trauma may cause changes in the bones and discs in the vertebral column, leading to a cascade of conditions that can affect nerve roots. This may cause neck pain and sometimes nerve damage.
- A problem inside the disc, Internal Disc Disruption, causes pain in the spine. This is believed to be due to leakage of irritating chemicals from the disc.
- Injury to the vertebra.
- Injury to the disc (discogenic pain or internal disc disruption.)
- Abnormal curvature of the spine (scoliosis)
How Is The Surgery Done?
A small incision is made to one side of the neck at the collar line. The trachea (windpipe) and the esophagus (food pipe) are pulled to one side. This gives clear access to the front of the vertebral bodies and to the discs so that discs and bone spurs can be removed easily.
A small PEEK cage is put into the space where the disc was removed. Alternatively, bone harvested from the patient’s hip or from a bone bank may be used. A titanium plate will be put over the bone plug to prevent it from moving.
The windpipe and the food pipe are returned to their usual place and the incision is closed. A small drain may be left in the incision site to drain excess fluid for 1-2 days. The incision is barely visible after a few months.
Your doctor may want you to wear a collar for a while. He will discuss that with you.
Risks For An Anterior Cervical Fusion
The satisfactory outcome rate for anterior cervical fusions is approximately 90% and complications are rare, but they do occur. There is always risk with any surgery, and you need to be aware of the possible risks and complications for this procedure. Before surgery, you will sign a “consent and disclosure” form stating that the risks have been explained, that you understand what surgery will be performed, and that you wish to proceed with the surgery. Listed will be 8 potential complications:
- Pain, numbness, and clumsiness could be experienced after surgery. Manipulation of nerves during surgery may result in inflammation or injury.
- Impaired muscle function. This refers to weakness or paralysis in the arms or legs.
- Incontinence or impotence. This refers to bowel, bladder or sexual functions. These are uncommon but may occur. The risk is higher if cord pressure is present at the timeof surgery
- Unstable spine. Sometimes the amount of bone needed to free the nerve is enough to cause weakness or instability of the vertebrae in the neck. If there is not enough bone left to provide the appropriate amount of stability, it might be necessary in the future to contemplate having more surgery later.
- Recurrence or continuation of pain. Symptoms may not go away even if the surgery is done correctly. There is a possibility that a disc that has been removed might rupture again. This occurs 10-15% of the time, even though it can be may be years later.
- Injury to major blood vessels. The area in front of the vertebral column immediately adjacent to the major large arteries and veins that come from the heart to supply the organs in the lower part of the body.
- Leakage of spinal fluid requiring re-operation. The dura is the hard covering of the nerves and spinal cord. Underneath the dura is the spinal fluid surrounding the nerves. If a hole is accidentally made in the dura then the spinal fluid could be allowed to exit this area. If that occurs while we are in surgery, then it is a fairly simple matter to place a stitch through the small tear and close the opening so that fluid can no longer exit. However, occasionally either the stitches will not hold, or there could be a small unrecognized tear, and leakage could occur. If that should happen, we may take you back to surgery and to another operation to sew up the hole in the dura. Usually this is not a major complication, but you need to be aware of this so that if it does occur it will not be a major shock or surprise to you.
- Complications with bone bank bone. Viral diseases such as AIDS and hepatitis could be transmitted. Massive effort has been made to avoid this, but it still remains a small possibility.
Additional Risks Include:
- Risk of infection, poor healing, or movement of the graft.
- Failure of fusion to occur. This occurs in approximately 5% of fusions in this area: the incidence is higher in smokers.
- There can be problems with the bone graft harvest site, resulting in numbness along the lateral leg or hip pain.
- Permanent or temporary hoarsness.
- Unequal pupils or blurred vision.
- Formation of blood clot in the wound could require re-operation.
- Ancillary risks include blood loss, infection, and discomfort.
There Are 4 Possible Outcomes From Any Surgery:
- Your symptoms or pain may be completely improved.
- Your symptoms or pain may be partially improved.
- Your symptoms or pain may be the same as before surgery-no better.
- Your symptoms or pain may be worse than before surgery.
Please discuss any concerns with your physician.
Tips To Maximize Recovery After Neck Surgery:
- Walk, walk, walk – as much as you can without causing neck or arm pain. Walking will help you deliver more blood to the healing area and will load the bone to help it heal.
- Be ultra aware of your posture. Your head will tend to move forward on your shoulders. Fight this tendency! Keep your head directly over your shoulders with your chin tucked in. You want to do everything you can to let all the structures in your neck heal in a good position.
- Support the low back with a firm cushion that will put an arch in your back when you sit. This will also help keep your head and shoulders straight. If you are in a seat with a high back or head rest, press the back of your head into the seat at times for some extra muscle support. Be sure to keep your chin tucked.
- The muscles in the front of the neck are usually weak after this surgery and can help support and protect the neck in you recondition them. Pressing your chin into the hard collar is one exercise. (Press for 10 seconds, 10 times, 10 times a day.) Once you are out of the collar, you can press into your fist. Be very careful to keep your head in a GOOD NEUTRAL POSTURE throughout this exercise.
- Practice swallowing several times in a row to help the muscles in the front of your neck regain their flexibility and smooth movement.
- Deep breathing, with effort to expand and contract the ribcage as much as possible is helpful for many systems in the body, but also can work the vertebra in the mid-back and reduce tension in the neck.
- Use an ice pack at the base of your skull for headaches.
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