An anterior cervical discectomy and fusion (ACDF) is a surgical procedure split into two parts.
The anterior cervical discectomy alleviates nerve root and spinal cord compression of the cervical spine by decompressing them. After that, an intervertebral fusion stabilises the surrounding vertebrae.
How is an anterior cervical discectomy and fusion performed?
Once a patient’s neck has been cleaned and prepared for surgery, a neurosurgeon will make a small incision on either the left or right front side. Then they will divide the thin muscle layer, known as the platysma muscle, underneath. The neurosurgeon will create a pathway towards the spinal column by following the natural planes that separate the delicate structures within the neck.
After the neurosurgeon confirms the affected area, they will perform a discectomy. This involves using a scalpel to remove disc material compressing the nerves or spinal cord.
The neurosurgeon will then conduct a rhizolysis to free any trapped nerve roots. They will begin by using a fine drill to remove any bony spurs compressing the nerve roots. When appropriate, they will enlarge the vertebral foramen (the tunnel through which the nerve roots exit the spine) to provide them with sufficient room.
Following the anterior cervical discectomy, they will begin the fusion. This involves fusing together two or more vertebrae so that they develop into a single and strong bone that provides the affected spine with stability.
If the patient’s own bone is being used for the fusion, the surgeon will make a small incision over the crest of the hip, harvest an appropriately sized portion of bone using a saw, and reshape the bone into place. If a titanium or PEEK cage is used, bone shavings containing proteins and bone-growing cells are placed into the cage, which is tapped gently into position. Depending on a patient’s circumstance, the neurosurgeon may reinforce the graft or cage with a metal plate to provide even greater stability.
To finish, a neurosurgeon will take a final X-ray to confirm the implant’s position and the alignment of the vertebrae. Once confirmed, they will close the wound with self-dissolving sutures. A dressing is placed over the wound, and in some cases, a wound drain may be used for one day after surgery.
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