Anterior Cervical Discectomy and Fusion (ACDF) is an effective procedure used to relieve pain and neurological symptoms caused by spinal stenosis and herniated discs. It is also used to treat degenerative disc disease in the cervical spine. This procedure substantially improves the quality of life. However, it also comes with long-term restrictions and an essential adjustment period. Understanding the long-term restrictions and adopting appropriate recovery methods can help you transition smoothly into post-surgical life.
Understanding Anterior Cervical Discectomy And Fusion (ACDF)
Healthy discs provide a flexible cushion between the bones, allowing the neck to rotate and bend. You can suffer from herniation or thinning, pinching the nerves due to wear and tear on the discs. Discectomy means ‘’cutting out the disc. A surgeon can carry out a discectomy anywhere along the spine from the neck to the lower back. The expert can reach the affected disc from the front of the spine through the throat. Your surgeon will move the neck muscles aside, exposing the esophagus, trachea, disc, and bony vertebrae. The procedure from the anterior of the neck is more easily accessible than from the back. The surgeon can easily access the disc without interfering with the spinal cord, strong neck muscles, and spinal nerves. One or several discs can be removed depending on your symptoms.
The space between the bony vertebrae will be empty once the disc has been extracted. Your surgeon will put a spacer bone graft to fill the open disc space. This is done to prevent the vertebrae from rubbing against each other and collapsing. The purpose of the graft is to bridge the gap between the two vertebrae, thereby enhancing spinal fusion. The vertebrae and bone graft are secured in place by screws and metal plates. Your body will start to heal naturally after surgery, as new bone cells will grow around the graft. The bone graft will fuse the two vertebrae, forming a single solid piece of bone after three to six months. The instrumentation and fusion will bind together like reinforced concrete.
You will experience a range of motion after fusion. However, this will vary according to the mobility of the neck before surgery and the number of levels fused. You can experience the same or even better range of motion than before surgery if only one level is fused. If several levels are fused, you can experience restrictions while turning your head and looking down or up.
Artificial disc replacement has been developed as an option for fusion. Similar to knee replacement, this disc is placed in the affected joint space to preserve motion, whereas fusion will remove motion. The results for ACDF and artificial disc are the same. However, artificial disc replacement is not suitable for patients with arthritis and weak bones. Your surgeon will advise you on whether ACDF or artificial disc replacement is the most appropriate option for you.
Candidates For ACDF Surgery
You qualify for ACDF if you are suffering from the following:
Cervical Stenosis or Myelopathy
Cervical stenosis is a condition characterized by the narrowing of the canal through which the spinal cord passes. This condition is caused by thickened ligaments, bulging discs, and enlarged facet joints. You can experience walking problems, weakness of the legs or arms, and pain because of spinal cord compression.
Degenerative Disc Disease
Degenerative disc disease is characterized by the shrinkage and drying of discs as you age. The vertebrae bones can rub or pinch the nerves as the disc thins. As a result, you can suffer disc herniation, bone spurs, or canal stenosis.
Herniated Disc
A herniated disc is a condition characterized by a rubbery center of the disc. The rubbery center can rupture or bulge through a weak area in the annulus. You can experience swelling and pain if this material presses on a nerve.
The ACDF Procedure
Most patients recover from a herniated disc after a few months of nonsurgical treatment. Your surgeon can offer you options if you are a candidate for ACDF. Before making a decision, consider all the risks and benefits. You can undergo fusion only if other treatments have failed.
Several bone grafts are available if you qualify for ACDF. An autograft is the gold standard for faster fusion and healing. However, the hip incision is often painful and can cause complications. Autograft material is inserted into the remaining disc space and can serve as a bridge between the bones as the body recovers. Each bone graft has merits and demerits, particularly if you smoke or have poor bone health. Some of the bone grafts available for ACDF include:
Bone Morphogenetic Protein (BMP)
Sometimes, BMP is added to bone-graft material to help stimulate the natural growth of the bone in the body.
Cellular Bone Matrix
Cellular bone matrix is an allograft from an organ donor that contains bone-generating stem cells. This putty is often shaped and added to grafts.
Allograft
An allograft is a bone from an organ donor that is collected and stored by a bone bank for later use. The graft has no proteins or bone-growing cells. An allograft is packed with living bone tissue shavings from the spine that are removed during the surgery.
Bone Marrow Aspirate (BMA)
A bone marrow aspirate is a sample of living bone marrow. The surgeon will collect it using a syringe from the vertebra or the hip. This procedure is often painless.
Autograft
Autograft is a living bone, and it contains bone-growing proteins in the marrow. Your surgeon can collect it from drillings during surgery. He/she can also extract it from the hip as an iliac crest bone graft. The collected bone is usually half an inch thick. Autograft has a higher rate of fusion. Its disadvantage is that you can experience pain in your hip.
An orthopedic surgeon or a neurosurgeon can carry out a spine surgery. Most spine surgeons possess the skills to handle complex spine surgeries. Seek the services of an experienced surgeon, particularly if your case is complicated or you have undergone several spinal surgeries.
What You Should Know After ACDF Surgery
ACDF can provide substantial relief from pain and restore function, but the healing journey requires commitment and careful attention to detail. Long-term healing will depend on how closely you follow the post-surgical instructions. You must also make crucial lifestyle adjustments. You should do the following after ACDF surgery:
Adhere To Post-Operative Instructions
Following the guidance provided by your surgeon and healthcare team is crucial for achieving long-term success after ACDF surgery. Your surgeon will guide you on the following:
- Keeping the surgical incision dry and clean. You will also be required to monitor signs of infection, like swelling, drainage, and redness. Ensuring proper wound care minimizes the risk of infection and promotes healing.
- Taking the right pain relievers, anti-inflammatories, or muscle relaxants as directed to address discomfort during the recovery period.
- Avoiding twisting motions, heavy lifting, or high-impact activities, like jumping and running, for some time. The restrictions help to protect the healing spine and prevent complications.
Be Patient
Healing after ACDF surgery often takes some time. Most patients typically start feeling better within a few weeks to a few months, but a full recovery can take several months. You should be patient and give your body ample time to recover fully. Your surgeon will monitor the healing process and advise you on when it is appropriate to resume normal activities.
Consider Long-Term Spine Care
It is vital to continue taking care of your spine for long-term health after recovering from ACDF surgery. Maintaining the health of the cervical spine and preventing future injuries is essential. This can be done through the following:
- Your surgeon can recommend regular check-ups to monitor the stability of the fusion, depending on your condition. This will ensure the spine stays in good condition over time.
- Engaging in spine-friendly habits, like proper posture, lifting techniques, and ergonomics at your desk or workplace.
- Engaging in periodic physical therapy is essential for maintaining flexibility and strength, particularly if you are at risk of developing degenerative spine conditions.
Avoiding Smoking
If you smoke, it is good to stop, particularly after ACDF surgery. Smoking affects the healing process and can increase the risk of complications and poor fusion. It also reduces blood flow, affecting oxygen and nutrient delivery to the healing tissues. This can prevent or delay the spinal fusion process from being successful.
Listen To Your Body
Healing from ACDF surgery is straightforward, but you should listen to your body and take necessary breaks. Reach out to your doctor immediately if you experience any unusual symptoms, such as increased pain, tingling, numbness, or weakness in the legs or arms. These can be signs of improper healing or complications.
Manage Your Weight
After ACDF surgery, maintaining a healthy weight is essential for the health of your spine. An increase in weight can increase stress on the cervical spine and lead to further complications or degeneration. Engaging in regular exercise, combined with a well-balanced diet, can help you maintain a healthy weight and promote long-term spine health. However, you should also consider the following:
- Staying hydrated is essential for spinal health. Hydration helps to maintain the flexibility and hydration of spinal discs.
- Eating anti-inflammatory foods like fruits, lean proteins, vegetables, whole grains, and omega-3 fatty acids. These often prevent inflammation and promote healing.
Stay Active, But Choose Low-Impact Activities
It is essential to stay active for your overall health and well-being after ACDF surgery. However, you should engage in activities that cannot put undue stress on the healing spine. The following are some of the low-impact exercises you should engage in:
- Pilates or yoga can help improve flexibility and strength once your surgeon has cleared you. However, avoid poses that exert excessive strain on your neck.
- Water aerobics or swimming offers gentle resistance while supporting your body weight. This helps in improving flexibility and strength without high impact.
- Walking is also an excellent way to stay active after ACDF surgery, as it improves circulation, promotes healing, and keeps you mobile without straining your neck.
You should avoid activities such as contact sports, running, and heavy lifting until your surgeon clears you to participate in these activities. Engaging in high-impact activities too early can affect the fusion and lead to complications.
Maintain Good Posture
Posture plays a significant role in the health of the spine, particularly during healing and in the years following ACDF surgery. Poor posture can exert unnecessary stress on the neck, leading to discomfort, pain, and potential complications. You should consider the following:
- Sleeping with a supportive pillow, which keeps the neck and head in a neutral position. Avoid sleeping on your stomach, as it can strain your neck and spine.
- Standing tall with your ears aligned over your shoulders. Avoid leaning forward or slumping, as this can strain your neck.
- Ensure the chair you sit on offers sufficient neck and back support. Ensure your spine is in a neutral position, with the shoulders relaxed and your head aligned with the spine.
Adhere To the Rehab And Physical Therapy Program
After ACDF surgery, physical therapy is a vital component of the healing process. The therapist will develop a tailored program that can strengthen the muscles supporting the spine and neck. Physical therapy is vital in the following ways:
- Avoiding compensation injuries — Your body can attempt to compensate for the healing area after surgery. The body can achieve this by overusing certain parts of the body, which can cause other problems. A physical therapist will guide you through exercises that can help prevent this from happening.
- Strengthening the muscles around the cervical spine that maintain proper posture and minimize pressure on the spine, preventing future injury.
- Restoring mobility — You can experience stiffness and a limited range of motion after ACDF surgery. Physical therapy can restore flexibility and movement slowly, while ensuring that the healing tissues are not overstressed.
Recovery And Prevention
Set a follow-up visit to your surgeon for two weeks after ACDF surgery. Healing can take four to six weeks. Your surgeon can take X-rays after a few weeks to assess whether the fusion is progressing. He/she will advise you on when to resume your job.
Sometimes, a brace or cervical collar can wear out during the healing process, which is necessary to provide support and limit motion while your neck fuses or heals. Your surgeon can recommend neck stretches and exercises, as well as physical therapy, once your neck has recovered.
You can experience stiffness, soreness, or pain at the incision if you had a bone graft taken from your hip. Get up every 20 minutes and take a walk. Avoid lying or sitting down for a long time. The following strategies can prevent recurrences of neck pain:
- An ergonomic work area
- Avoiding smoking, and
- Proper lifting methods
The Risks of ACDF Surgery
Every surgery has risks. The common complications of most surgeries include reactions to anesthesia, blood clots, infection, and bleeding. There is a high risk of complications if spinal fusion is performed at the same time as a discectomy. The following are the complications associated with ACDF surgery:
Nerve Damage or Pain
Every surgery has a risk of destroying the spinal cord or nerves. Damage could cause paralysis or numbness. However, nerve damage from the disc herniation itself is the leading cause of persistent pain. Some disc herniations can cause long-term damage to the nerves, making them unresponsive to surgery. The compressed nerve does not spring back. Spinal cord stimulations or other medications can provide relief in these situations.
Adjacent Segment Disease
Extra stress and load can be transferred to the discs and bones above or below the fusion after the fusion of a spine segment. Wear and tear can degenerate the adjacent level discs, causing pain.
Bone Graft Migration
Though not common, after ACDF surgery, the bone graft can move from the correct position between the vertebrae. This often happens if screws and plates are not used or if several vertebral levels are fused. Your surgeon can recommend another surgery if this happens.
Hardware Fracture
Hardware is the plates and metal screws used to stabilize the spine. The hardware can break or move before the bones are properly fused. You will be booked for a second surgery to replace or fix the hardware if this happens.
Vertebrae Failing To Fuse
Bones can fail to fuse together for many reasons. The common reasons include malnutrition, obesity, osteoporosis, and smoking. Smoking is the main reason that prevents fusion. Nicotine is a toxin that prevents bone-growing cells. You can affect the fusion process if you continue to smoke after the ACDF surgery.
Hoarseness And Swallowing Difficulties
Temporary hoarseness can happen in some situations. During the surgery, the recurrent laryngeal nerve that controls the vocal cords can be affected. This nerve can heal after several months. In rare cases, swallowing and hoarseness issues can persist. If this happens, it is essential to consult a throat, nose, or ear specialist.
Find a Reliable ACDF Surgeon Near Me
ACDF surgery is a crucial procedure for people struggling with certain spinal conditions. The surgery mainly focuses on the cervical spine and is a proven medical procedure that enhances the quality of life for many. When a disc in the cervical spine is damaged or slips out of place, you can experience discomfort. During ACDF surgery, the surgeon removes the troublesome disc to ease the pressure on your spinal cord and nerves.
Recovery is a crucial phase after ACDF surgery. Initially, a patient can experience discomfort like a stiff neck or difficulty swallowing. However, these symptoms ease with time. The recovery period can vary from patient to patient, but most people resume normal activities after four to six weeks. Adherence to the doctor’s instructions post-surgery is crucial. If you need reliable ACDF surgery in Los Angeles, contact LAMIS. Call us at 310-734-6088 to speak to one of our experts.
