ACDF or anterior cervical discectomy and fusion or Cervical ADR or artificial disc replacement is considered when a patient has a bulging cervical disc that causes compression of either the spinal cord causing dysfunction of the spinal cord (myelopathy) or compression of a nerve that causes weakness of the arm or pain radiating down the arm (radiculopathy). Or sometimes both. The bulging disc may also be accompanied by bone spurs that may also contribute to the problem.

ACDF is usually done when there is a significant disc bulge and bone spur causing pressure on the nerves and the spinal cord. This surgery is done through the front of the neck, and the disc, bony spurs and any compressive elements are removed entirely. The space created is filled with an implant and bone or bone substitute promote the bones above and below to join (or fuse) over time.

An ADR is usually considered in younger people with fewer bony spurs and instead of putting in an implant that promotes fusion, an artificial disc is inserted in to the space to allow for a natural movement of the spine.

While the procedures are straight forward, every surgery has a very small risk of bleeding or infection. Some patients may have difficulty in swallowing for the first few days and this usually resolves in 3 to 5 days. The other complaint after surgery is hoarseness of voice that again usually improves but very rarely (1/1,000) may be permanent.

Post operative recovery is usually easy and most patients have a drain in the incision area for a day. Some general precautions are:

  • Pain Management: Medication to manage post-surgical pain.
  • Neck Brace/Collar: Soft or rigid cervical collar for a period to support the neck and limit movement.
  • Incision Care: The wound is usually closed with dissolving stitches.
  • Activity Restrictions: Avoid heavy lifting, twisting, and strenuous activities, including driving for a few months.
  • Follow-Up Appointments: Usually a week after surgery and then a month and then 6 monthly.
  • Physical Therapy: Often recommended to help regain strength, flexibility, and proper posture and exercises have to be followed for life.
  • Avoid Smoking: Smoking significantly impairs bone healing and can increase the risk of failed fusion in ACDF.