Anterior Cervical Discectomy and Fusion
This is Dr. Scott Farley, I am an orthopedic spine surgeon. We are going to talk today about doing what we can an anterior, so, front of the neck, cervical, again neck, discectomy, so removal of disc material and a fusion with placement of an anterior cervical plate. I am going to show you is, have a brief discussion about why this procedure would be performed. I am going to try to show you visually rather than a simple animation, so you can see what is actually placed into your body.
The reason for an anterior cervical discectomy and fusion, or an acronym people use ACDF which is just the first letter of all of those words, anterior cervical discectomy and fusion. The idea behind this and the reason for this procedure can be one of many reasons. It could be from an infection It could be from a tumor. It could be from a degenerative or an aging process. It could be a fracture. It could be abnormal or instability to a specific spinal segment. It could be for a disc that is herniated causing significant arm pain. These are a few of the reasons why an anterior cervical discectomy with fusion may be required.
So, a patient in our practice, my practice, and in anybody’s practice, you would fail what we call conservative treatment. [including] Physical therapy, oral medication, time, cervical traction, using home heat and ice, using oral medications again like Neurontin, pain medications, medications like LYRICA® which may help with nerve pain. A patient then goes through treatment and not having benefit. A patient will likely undergo an epidural steroid injection, and/or a facet or joint injection procedure, and a patient’s pain would continue.
We talk about continuing pain and the amount of time would depend on again if this is a fracture or if we are talking about more of a degenerative change. So, the time frame for someone needing an anterior cervical discectomy and fusion may be emergently or it may be many years, after many years of treatment.
So, that being said if a patient of mine requires an anterior cervical discectomy and fusion, the procedure is the idea that a motion segment in the body, it’s made up of two joints, the right and the left, the right facet joint, and its corresponding disc. So, in this case it would be the C3, C4 level. And this would be the level above what I am going to show you as the fusion level, but you get an idea of how rigid it will make this motion segment. I am going to use a larger model which is actually a lower lumbar that gives you a better visualization of what happens in this procedure.
The disc material is removed in its entirety. So, then I will open it up, the disc is removed and any material that is in the back portion that is causing any pressure on the spinal cord, where my finger is, is removed from the front and the endplate or the ends of the bone are fashioned, made flat and are exposed properly for placing an interspinous, or an interbody fusion cage. This can be bone graft, a bone graft plug, it can be plastic, what we call PEAK, it could be metal, and this is placed and packed with bone graft. So, it would look like this from the side, from the front it would be flush and would not be causing pressure on the spinal canal. This would be placed between the two bones. So, now to add rigidity, or to make this a more rigid segment to help with healing, an anterior cervical plate will be applied across the vertebral body with four screws, two on the top and two on the bottom. So, if you are looking from the front [of the spinal segment], the plate will occupy the spacing across this [this space between the C3 C4 vertebral segment] with the screws going two into each vertebral body. That will look like this from the front [vertebra with metal plate and screws] view, this is the anterior vertebral cervical plate. This would be place inside of the body. This would be expected to remain in place for the life of the patient. This plate you will see, this is an older model, but you will see a significant rigidity to the actual joints in that segment, versus the joints above and below, even in this model are quite mobile. You can see that I can’t move that segment at all, just with this being put through what we call saw bones, which is very soft bones, which is a very rigid construct.
So, again this is called an anterior cervical discectomy and fusion. For pain, instability, possibly a fracture are the most common reasons for this procedure. You would expect to be in the hospital for a 23 hour stay. Some physicians may have you go home the same day. In my experience, it’s I believe safer to stay in the hospital over the course of one night in case there is a complication such as bleeding or a hematoma. So, there are medical providers, nursing staff able to watch and monitor the patient, then the patient can go home the very next day.
A patient, I would expect be wearing a cervical collar for between 4 weeks and 6 weeks depending on how rigid the screws are into the actual bone. So, if someone was younger and had very strong bone with very stable purchase at the plate, they may use the cervical collar after the procedure for a shorter period of time. Someone who is a little bit older who may have thinner bone or a bit more osteopenia may require a cervical collar for a longer period of time. Again, that would be determined by the patient and what they can tolerate postoperatively.
This procedure is a very effective procedure for arm pain and for neck pain, for the right patients and for the right reasons.
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