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Spine Treatments

Anterior Cervical Discectomy and Fusion (ACDF)

Anterior cervical discectomy and fusion is the gold-standard surgical treatment for a herniated cervical disc when there is severe or progressive neurological damage and significant pain that does not respond to non-surgical treatments. It involves removing the herniated disc (discectomy) to relieve pressure on the nerve roots or spinal cord and then fusing the bones with a graft of bone or synthetic materials. It is typically an outpatient procedure, but in some cases, you may spend one night in the hospital.

Anterior cervical decompression and fusion are indicated for conditions that cause significant spinal cord or nerve root compression, leading to symptoms such as:

  • Chronic and severe neck pain due to a pinched nerve or spinal stenosis from arthritis and bone spurs
  • Radiculopathy (nerve pain, weakness, or numbness extending into the arms or legs)
  • Myelopathy (spinal cord compression causing coordination difficulties, gait disturbances, and other neurological deficits)
  • Cervical degenerative disc disease that has not responded to conservative treatment methods

An anterior cervical decompression and fusion aims to alleviate pain, restore function, and prevent further deterioration in the affected area of the spine. ACDF will give you pain relief, but you may lose some neck flexibility. In some patients, the pain before surgery is so severe that it limits the range of motion; after surgery, when the pain improves, the patient may actually notice an improvement in neck mobility, strength, and endurance.

ACDF is generally effective in relieving the symptoms associated with cervical nerve root or spinal cord compression. The success rates for reducing pain and restoring function are high, with many studies reporting improvement in over 80% of patients. However, the effectiveness of the surgery depends on various factors, including the specific pathology addressed, the overall health of the patient, and the presence of any co-morbid conditions.

A good candidate for anterior cervical discectomy and fusion is typically a patient who exhibits specific clinical symptoms and radiological findings indicating nerve root or spinal cord compression in the cervical region that has not adequately responded to non-surgical treatment modalities such as physical therapy, chiropractic care, or interventional pain procedures. Here are detailed criteria for identifying suitable candidates:

  • Persistent Pain: Individuals who experience chronic neck pain associated with radiculopathy (radiating pain, weakness, or numbness in the arms) or myelopathy (spinal cord compression symptoms such as difficulty with coordination, balance, or fine motor skills).
  • Neurological Deficits: Symptoms such as muscle weakness, reflex changes, or sensory deficits that correlate with imaging findings of nerve compression.
  • Quality of Life Impact: Significant impairment in daily activities and quality of life due to symptoms.

  • Disc Herniation or Degeneration: MRI or CT scans showing disc abnormalities correlating with the patient’s clinical symptoms.
  • Spinal Stenosis: Narrowing the spinal canal or foramina (openings through which nerves exit the spine) causing nerve compression.
  • Failed Conservative Management: Documented failure of conservative treatments such as physical therapy, medications, and corticosteroid injections over a reasonable period (typically at least six weeks to several months).

  • Overall Health: Good candidates are typically those without significant medical comorbidities that would increase the risk of surgery or impair healing and recovery.
  • Realistic Expectations: Patients should clearly understand the potential benefits and risks of the surgery, including the possibility of needing additional surgeries in the future.

Conversely, certain conditions may contraindicate ACDF, including:

  • Active infections, particularly spinal infections.
  • Severe osteoporosis could complicate the fusion process.
  • Certain systemic diseases that are poorly controlled, such as diabetes or autoimmune disorders, might impair healing.

Each patient’s situation must be evaluated on a case-by-case basis, considering both the potential benefits and risks of the surgery. Dr. Ball will thoroughly assess if this is the most appropriate surgical option for you. He will also discuss the risks and benefits of the procedure to ensure you have the information you need to make an informed decision about pursuing this procedure.

  • The patient receives anesthesia, and the surgical area is cleaned and prepared.
  • A 1″- 2 ” incision is made in the front of the neck.
  • Discectomy: The degenerated or damaged disc and other damaged soft tissues are removed to relieve the nerve root or spinal column compression.
  • Fusion: The space left by the removed disc is filled with a bone graft or a synthetic implant. Over time, the graft or implant fuses with the adjacent vertebrae, stabilizing that spine segment.
  • The incision is closed, usually over a surgical drain, and the operation is over.

Recovery and rehabilitation following ACDF involve several stages:

  • Immediate postoperative care involves pain medication management and a cervical collar to support the neck.
  • Physical therapy begins once the acute postoperative period is over. Initially, it focuses on gentle range-of-motion exercises to improve flexibility and prevent stiffness.
  • As recovery progresses, exercises to strengthen the neck and upper back muscles are gradually introduced.
  • Patients are educated on protecting their necks and avoiding activities that may stress the cervical spine.
  • Regular follow-up appointments are necessary to monitor the progress of fusion using imaging techniques such as X-rays or CT scans.

Complete fusion can take several months, and full recovery may vary from one individual to another, typically ranging from a few months to a year. To maximize recovery outcomes, patients must adhere to their rehabilitation program and follow their surgeon’s advice.

When you have disabling neck pain that interferes with your quality of life, contact Dr. Hieu Ball at CalSpine MD with offices in San Ramon. He offers a full range of treatments for neck pain. Dr. Ball offers state-of-the-art patient-centered care for patients with neck, mid-back, and low-back problems. He received his orthopedic surgery and spine surgery residency and fellowship training at Harvard Medical School and UCLA-affiliated institutions. Education included training at Massachusetts General Hospital, Brigham and Women’s Hospital, and Boston Children’s Hospital. Dr. Ball is a double fellowship-trained orthopedic spine surgeon. He received a pediatric spine fellowship at Boston Children’s Hospital and a second adult spine fellowship at UCLA. Dr. Ball offers minimally invasive spine care, and many procedures often may be performed on an outpatient basis in an ambulatory surgical center setting.

At a Glance

Dr. Hieu Ball

  • Double fellowship-trained orthopedic
  • Orthopedic surgery residency at Harvard Medical School
  • Over 20 years of spine surgery experience
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