ANTERIOR CERVICAL DISECTOMY AND FUSION
One of the most common neck conditions that occurs with age is Cervical Spondylotic Myelopathy (CSM). Over time, the normal wear-and-tear effects of aging can lead to degenerative changes of the discs – compressing, or squeezing, the spinal cord. CSM can cause a variety of symptoms, including pain, numbness, weakness and tingling.
Patients that come to see a spine specialists may worry that they need surgery, but the vast majority of people that are seen get better with conservative treatments involving steroid treatments, physical therapy, manual decompression, and weight loss. While surgery may be necessary one day only about 5-10% of people that walk through the door end up needing a surgical intervention. One of the surgical techniques for treating CSM is the Anterior Cervical Discectomy and Fusion (ACDF) procedure. It is a two-step process which includes a discectomy, a form of surgical decompression that removes the problem disc and a fusion used to stabilize the cervical segment.
During this procedure, a surgeon removes the problem disc(s) through an anterior approach (through the front of the neck) to relieve spinal cord or nerve root pressure ̶ ultimately alleviating corresponding pain, weakness, numbness and tingling. The portions removed are then reconstructed by inserting bone grafts within each disc space to support the normal loads of the cervical spine. The bone grafts can be composed of:
- Autograft – your own bone tissue harvested from your hip
- Allograft – donor bone tissue
- Synthetic – man made substitutes that are biologically compatible. This category includes fusion cages.
When preparing for the prospect of cervical surgery the most important thing to do before proceeding is to quit smoking for at least 30 days prior to surgery. Given the nature of the procedure it should be understood that statistically smoking within a month of the procedure can cause a surgical failure rate of up to 40% on the upper limit from the 8% comparable to non-smokers.
After an anterior cervical discectomy and fusion a recovery time of 4-6 weeks is to be expected. During this time wearing a neck brace to prevent movement during healing is often utilized. The day of the surgery if there is not complications such as uncontrolled blood pressure or difficulty breathing you can expect to go home the day of the surgery. The surgeon will give you instructions for recovery that need to be followed with close attention to how your body is responding. Symptoms such as redness, swelling, discharge, constipation, fever, or trouble breathing need to be reported to you surgeon immediately with no concern for if it is appropriate to call; Your surgeon wants to know and given the proximity to your spinal cord and brain you want them to know too! Approximately 92% of patients that undergo this procedure see a relief from symptoms. Impinged nerves are on a timeline from when symptoms appear with a bias of doing better the less time they are impinged.