• Herniation disc
• Hypertrophied ligaments
• Osteophytes (bony outgrowth)
• Tumours or infection
• Fracture and/or dislocation

To relieve compression on the nerve root or spinal cord and it is preferred when compression is from front/anteriorly to the spinal cord.

• Failure to obtain radicular arm pain relief despite an adequate trial (6-8 weeks) of non-operative treatment.
• Progressive motor weakness in the arm(s) or incapacitating pain.
• Spinal cord compression with myelopathy symptoms needs urgent surgery

• When the source of compression is posterior to the spinal cord.
• The lack of correlation between clinical symptoms and MRI imaging.

Anesthesia

• Surgery is performed in general anesthesia, the patient will be fully asleep.

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Patient position

• Patients are positioned in the supine (lying on the back) position on the operating table.

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Procedure

• A 5-centimeter horizontal incision is made in front of the neck, preferably along the skin crease (to reduce future scar). The level is confirmed with intraoperative fluoroscopy. The spine is exposed by moving aside the neck muscles, trachea, and esophagus on one side and major vessels to another side. After the disc is removed, the space between the bony vertebrae is filled with a bone graft or a spacer bone graft. The graft serves as a bridge between the two vertebrae to create a spinal fusion which usually takes 3 months. The bone graft and vertebrae are fixed in place with metal plates and screws. The wound area is usually washed out with sterile water containing antibiotics. The surgical wound is closed with subcuticular self-absorbable sutures leaving a minimal scar. The total surgery time is approximately 90-120 minutes.

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Post-Operative Care

• After 1-2 hours of monitoring in the recovery room, patients are shifted to ward. Oral fluid intake started after 4 hours and gradually switched to a full diet. Most of the patients can stand and walk by the evening or the next morning with good pain tolerance and can be sent home accordingly in 1-2 days.

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Home Care

• To follow proper techniques of getting in and out of bed and walking independently. The patient should walk and stay active as much as possible and can climb stairs if required. The patient should avoid excessive rotation and extension of neck activities and avoid lifting (more than 2-3 kg).

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Brace

• Usually not required, however one can wear a soft neck collar if the patient finds it comfortable.

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Wound Care and follow up

• Before leaving the hospital, a waterproof dressing is applied to the surgical wound, and the patient can take shower and will be called on the 5th post-op day for a dressing checkup and change of medication if needed.

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Return to work

• The patient can resume light work or driving once the pain is tolerable, usually in a week to 10 days. While heavy work and sports activity should be avoided for at least 3 months after the surgery.

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Complications

ACDF is generally considered a very safe procedure, however, like any other surgery, there are several risks and complications associated with are:

• Operative wound infection
• Hoarseness of voice and difficulty in swallowing
• Dural tear and CSF leakage
• Bleeding
• Implant related complication- loose screw, broken implant
• Adjacent segment disease
• Pseudoarthrosis or non-union
• Nerve root damage
• Bowel/bladder incontinence
• Deep vein thrombosis, which occurs when blood clots form in the leg

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Result of surgery

• ACDF is a very safe surgery and successful in relieving arm pain in approximately 95- 100% of patients, however, neck pain improvement is a little less predictable than radicular arm pain. The use of plate and screw fixation in addition to bone graft has increased the fusion rate from 93% to nearly 100%.

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