Acdf

What is an anterior cervical decompression and fusion?

This involves removing the compression of nerves in the neck causing arm pain due to degenerate disc bulges, and then fusing one or more cervical vertebra together to achieve stability and prevent further problems.

What does it involve?

You come to hospital on the day of the operation.  The procedure is performed using a general anaesthetic.  You will have a small horizontal scar on the front side of your neck to allow approach to the front of your cervical spine.  The disc is removed and compression on the nerves is removed.  A cage containing bone graft is inserted into the disc space to allow it to fuse together and achieve stability.

What are the alternatives?

Continue with conservative measures: these include taking pain killers and staying as active as possible.  Performing physiotherapy exercises to reduce muscle spasm and keep your core muscles functioning is important.  Some people find their symptoms can resolve after an initial flare up whilst others find they can manage their pain by adapting their daily activities.

Nerve root injection: this puts some steroid around the painful nerves and aims to reduce the inflammation in this area.  It often helps nerve pain and, for disc prolapses, this may be all that is required.  However, for more degenerate long-term bulges and changes, it does not take away the underlying compression on the nerves so may only have a temporary effect.

Some surgeons advocate use of cervical disc replacements.  If this is of interest to you, I would be happy to discuss this with you and refer you to someone who undertakes this, if required.

Posterior foraminotomy may be indicated if there is an acute disc prolapse or compression of the nerves from posterior bony structures.

Post-operative recovery?

You will start to mobilise out of bed fairly soon after the operation.  Most people stay in hospital overnight.  When you go home, your neck will be sore but this will quickly settle over the course of 2-3 weeks.  Changing your position regularly will help reduce muscle stiffness in your neck.  You may have a sore throat or feel it is uncomfortable to swallow for a few days but this normally settles very quickly.

You will have a dressing covering your scar for at least 2 weeks and this will be checked by a healthcare professional to ensure it is healing well.  Please do not remove this by yourself.

It is important to stay active and aim to take 2 or 3 short walks a day, gradually building up the distance you are walking.  It may be beneficial to start physiotherapy exercises and gentle core stability work at 4-6 weeks following the operation.

The fusion takes between six and nine months to consolidate so it is advisable to avoid strenuous activities, heavy lifting, and awkward twisting for at least the first two or three months to allow the fusion to start to form.

Medications: Continue taking your normal medications after the operation and, when the pain starts to improve, you can reduce them gradually one at a time.  There are some medications that should not be stopped abruptly so please check with your doctor about this.

Arm and neck symptoms: Some people find their arm pain disappears immediately, whilst others may find it takes a few weeks for any nerve inflammation to settle down.  The pain may disappear but some people do experience numbness down the arm, which often reduces in size over subsequent months.  If you have arm weakness due to nerve compression prior to the operation, this may slowly improve over the next 18 months; however, it may not return to normal.  Your neck pain can slowly improve over the course of many months as your muscles start to function more effectively with regular gentle physical activity.

Post-operative problems: if you experience any unexpected symptoms, please seek medical advice.  Seek immediate advice if: (1) you feel your neck is swelling or you have problems breathing or swallowing; (2) you cannot pass urine, develop numbness around your buttocks, or weakness in your arms or legs; (3) you feel unwell and the wound is red or oozing,

Returning to work: for office-based jobs, you may be able to return at around four to six weeks after the operation.  For more manual jobs, you may require light duties initially.  Consider returning to work part-time for the first one or two weeks to ensure you are comfortable.