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Anterior Cervical Corpectomy Fusion (ACCF)

ANTERIOR CERVICAL CORPECTOMY AND FUSION (ACCF)

WHAT IS THE CERVICAL SPINE?

CERVICAL SPINE

The cervical spine is composed of seven bones starting with the C1.  C stands for cervical, and the 1 indicates the position in the series.  C1 is also called the Atlus with a nod to Greek mythology, because just at Atlus supported the world on his shoulders the C1 directly supports the weight of the skull without a disc for cushion.  Each bone counting down from C1 gets assigned a number based on its position in the series;  The bones are ordered C1, C2, C3, C4, C5, C6, and C7.  After C7 the bones are part of the twelve bone Thoracic series.  A disc connects and cushions each vertebrae in the cervical spine.

CERVICAL DISCS

The C1-C2, C2-C3, C3-C4, C4-C5, C5-C6, and C6-C7 discs comprise the six cervical discs in the cervical spine.  Structurally the discs in the cervical spine function the same way as discs in other parts of the spine.

Cervical discs have three purposes:

  • cushioning the force applied to the spine to protect the vertebrae from damaging each other.
  • acting as connective tissue to keep the cervical discs in place.
  • acting as a cartilaginous joint to allow us to have a range of motion between bones to turn or bend the spine.

Cervical discs anatomy is comprised of two components.  One component, the Annulus Fibrosus, is a tough fibrous exterior to keep the discs shape and position.  The Annulus Fibrosus is essentially collagen sheets stacked concentrically inside each other like a Russian nesting doll.  The other component is the gel like center inside of the disc, called the Nucleus Populous, comprised of collagen fibers and a mucoprotien gel.  The Nucleus Populous acts as a internal tension cushioning to oppose the everyday impacts from movement.  The mucoprotien gel inside of the disc is what causes the inflammatory response on nerves when a disc ruptures.

WHAT IS A ANTERIOR CERVICAL CORPECTOMY AND FUSION MEAN?

WHAT DOES ANTERIOR MEAN?

Often in medicine you may hear positioning terms like anterior, posterior, proximal, and distal.  Here are what they mean:

  • Anterior – front of the body
  • Posterior – back of the body
  • Proximal – closer to the head
  • Distal – farther from the head

WHAT DOES CERVICAL MEAN

The spine is composed of four sections:

  • Cervical – the top 7 bones in the spine connecting the skull to the thoracic spine.  This is often referred to as the neck.
  • Thoracic – the 12 bones in the region of the spine that attaches to the cervical spine and the lumbar spine.  This is the upper region of your back that contains ribs.
  • Lumbar – the 5 bones in the region of the spine that composes the lower back.  The lumbar region is connected to the Thoracic and the Sacral regions of the spine.
  • Sacral – this is composed of 5-7 bones that fuse together at the base of the spine below the lumbar spine.  This region of fused bones along with the hips comprises what is called the pelvic girdle.

WHAT DOES CORPECTOMY MEAN

Corpectomy broken down into its two parts means body and to remove.  In this case we use the word corpectomy to convey the removal of the entire or partial piece of the vertebral body (bone).

WHAT DOES FUSION MEAN

Fusing means to take two things and make them one.  In the case of orthopedic spine surgery this means metal hardware will attach two or more bones together.

PUTTING IT ALL TOGETHER

Anterior Cervical Corpectomy and Fusion:

  • Anterior – the surgical approach is from the front of the
  • Cervical – the location is in one of the seven top bones in the neck
  • Corpectomy – some or all of a bone will be removed
  • Fusion – two bones will become connected and will not have motion between them.

Anterior Cervical Corpectomy and Fusion procedure

This procedure is similar to discectomy, except a larger and more vertical incision in the neck will be required to allow more exposure so that the entire vertebra can be removed.  In some cases, both disc and bone may be pressing on the spinal cord and a combination of discectomy and corpectomy may be performed.  Once the vertebra, disc(s), bone spurs and disc fragments are removed, a spinal fusion is required to stabilize the spine.  Spinal fusion is essentially a “welding” process. The basic idea is to fuse together spinal bones (vertebrae) so that they heal into a single, solid bone.

In addition to bone grafts, metal plates and screws are commonly used to fuse the bones in place. Fusion will take away some spinal flexibility. The degree of limitation depends upon how many spine segments or “levels” are involved.