One of the most common and successful spine surgery procedures is the Anterior Cervical Discectomy and Fusion, also called ACD or ACDF. This surgery involves an incision at the front or anterior aspect of your neck just off the midline. The cervical spine is accessed by passing the trachea, carotid artery, and esophagus. The damaged or degenerated disc or discs is/ are removed and bone or polymer spacers are inserted into the disc space to promote fusion. Typically screws and a titanium plate are used to immobilize the levels to allow the fusion to occur. Newer implants allow screws to be placed through the spacer implant without a plate.
The ACD surgery is very safe but there are both immediate and long term risks to understand. Immediate risks involve stretching or damage to the nerves and tissues along the surgical site. The esophagus lies just in front of the cervical spine so it must be retracted during the surgery. This retraction can result in swallowing difficulty after surgery. The anterior plate used for fusion also may contribute to swallowing difficulty. Multilevel fusions often are associated with more severe swallowing difficulty. Another risk is injury to the recurrent laryngeal nerve causing hoarse voice. This injury can take months to improve but is rare.
One of the main long term risks to cervical fusion is Adjacent Level Disease. When one or more disc levels are fused causing immobilization of those level(s), the resulting fused block of vertebrae places higher strain on the disc levels above and below the fusion. Further degeneration of the levels above or below the fusion can cause a return of pain and symptoms years after the cervical fusion.
There are many alternatives to cervical fusion surgery. In most cases, cervical discectomy and fusion is the appropriate treatment, but it is important to understand the risks and alternatives. Sometimes a good outcome can be achieved without a fusion.
Learn about the alternatives to cervical fusion by following the link below to Alternatives to Cervical Cervical Fusion Section. In some a spinal cord stimulator can effectively treat neck, arm, and head pain without a fusion or decompressive surgery. Follow the Spinal Cord Stimulation link for more information.
If you have been told you need cervical fusion surgery or are having continued symptoms after conservative therapy such as physical therapy or epidural injections, visit the Contact Us section to review your MRI scan with Dr. Hua and discuss your surgical and nonsurgical options. If you would like to see Dr. Hua in person, Dr. Hua also has offices located in the San Francisco Bay area as well as in Central California and in the Los Angeles Area.
by Sherwin Hua