ACDF Surgery: Anterior Cervical Discectomy and Fusion Explained

Anterior Cervical Discectomy and Fusion (ACDF) was first developed in 1955 by multiple surgeons working independently on potential remedies for cervical spine instability (1, 2). In its original form, ACDF involved replacing a disc in the cervical spine through an incision in the front of the neck, after which a piece of bone from the hip was inserted to promote fusion of adjacent vertebrae. Though some have investigated alternative techniques for promoting spine fusion, the procedure has remained the same for much of the last 70 years due to its reproducibility and consistency in improving the lives of patients with degenerative spine disease (2). This article discusses some of the conditions treated with ACDF, the basics of the procedure, and expectations for recovery following ACDF surgery. For more information on ACDF, see the citations sections below or discuss your case with a licensed healthcare professional.

ACDF is used for a variety of conditions that cause pain and stiffness in the neck due to disease of the upper (cervical) spine. Typically, ACDF is used as a second-line treatment after a trial of conservative management using over-the-counter pain medications and physical therapy for several months. In rare cases of rapidly progressive, degenerative spinal disease, ACDF may be recommended earlier on in the care process. Some of the specific issues surgeons may treat with ACDF include (3-5):

• Cervical Disc Herniation
• Cervical Stenosis
• Degenerative (Cervical) Disc Disease
• Cervical Spondylosis

Recovery ACDF follows a predictable timeline with three key phases. Recovery is fastest in the six weeks following surgery, with most major milestones for recovery occurring during this period (7). Most patients are discharged the day after ACDF and can return to both driving and work around two weeks after their operation (8). Arm pain associated with spine disease tends to recover more quickly following surgery, typically improving by ten days post-operatively, compared to an average time to improvement for neck pain of 24 days (7). The second phase of recovery happens from six weeks to four months after surgery, during which improvement remains steady but tends to slow down. The final period is referred to as the plateau phase, and involves further stabilization and maintenance of improvement from earlier periods of recovery. On average, patients report a 54% improvement in arm pain and a 44% improvement in neck pain at one year following their operation, with 85-95% reporting that their surgery was a success ten years after surgery (7). Recovery is an individual process, and you should follow the guidance of your treating spine surgeon to maximize your chances for a smooth and sustainable recovery.