What is Anterior Anterior Cervical Dissectomy & Fusion Surgery?
An Anterior Cervical Discectomy and Fusion (ACDF) procedure is a kind of cervical spine surgery done from the front or anterior of the neck. This procedure takes care of all spinal problems. ACDF surgery is an extremely common and successful procedure that is done for spinal problems. In this procedure, the surgeon removes the damaged disc and the bone that's growing between the vertebrae above and below it. The surgeon may decide to perform this surgery using an implant like a plate to offer comprehensive support until fusion takes place.
Anterior approaches as performed in ACDF, do not involve much of stripping of the muscle from the spine and permit good access to the vertebral discs in the anterior of the spine, as compared to a posterior surgery. This approach provides the surgeon with an easy approach to the cervical spine, with patients not having too much pain from incisions made using this approach.
When is ACDF the best solution?
In the cervical spine, surgeons often perform this surgery using an anterior approach to address issues like fractures, tumors or degenerative disorders. If your doctor finds that you need an inter-body fusion, have good bones and have experienced six weeks of non-surgical treatment, he may consider you a good candidate for an ACDF procedure.
On the other hand, he may not consider you an ideal candidate for this procedure if he finds you inadequate for fusion surgery due to any other medical conditions you may have. These conditions include infection or inflammation near the site of procedure, sensitivity to implant materials, weak bone quality and any other symptoms.
For your doctor to consider you a good candidate for ACDF surgery, you should have the following symptoms:
- Nerve compression leading to motor weakness
- Unbearable nerve pain or pain that forces you to stop certain activities
- Degenerative disc leading to unbearable neck pain
- Progressive deformity
- Spinal cord compression perhaps progressing to Myelopathy
How do doctors perform this surgery?
Usually, the doctor will make a small cut in the treatment area. Its size can vary based on the complexity of your case or on any other parameters. The surgeon then removes the damaged or diseased disc so that the pressure it causes on the nerve root or symptomatic cord reduces considerably and brings relief to the patient.
The surgeon then inserts an implant into the void that remains after removal of the damaged disc. This implant takes on the role of a mechanical support for the vertebrae while new bone grows between vertebrae during the bone healing or fusion period. This part of the spine will stabilize after fusion takes place. He then places a small plate and a few screws on the disc space as an internal brace so that everything is held firmly in place while fusion takes place.
Types of procedures that can repair ACDF:
Minimally invasive neck surgery: There is another procedure that is safer and gives better results than the traditional surgery. It is a minimally invasive neck surgery that's a good alternative to the ACDF neck surgery since it does not demand grafts or implants and is performed by making a small neck incision. Next, the damaged disc is removed and replaced with an artificial disc to offer the spine the required stability. This approach to cervical fusion gives patients better results in a shorter recovery period than those who undergo the conventional open neck procedures.
Inter-body Fusion: Inter-body fusion involves placing fusion cages and bone graft into the gap between two vertebrae. This is a very good method of achieving fusion. This fusion cage can be made from metal, bone or carbon fibre. Often, bone graft and bone healing protein are put inside the cage and within the inter-body space so that the bones may heal.
The intervertebral cage helps to keep the two vertebrae separate and hold them apart. It also helps increase the orifice around the nerve roots, thereby lifting all nerve pressure. The intervertebral cage also helps to set right any spinal deformity and body misalignment. These cages can be implanted from either the front of the spine, or the side or back.
Where the surgeon actually chooses to do the procedure depends on the patient's particular anatomy, besides the nerve pressure areas and the amount of pressure from around the nerves in the vertebral canal. For stability, the surgeon may also decide to use some more surgical hardware in the front of the neck.
Bone Grafting: Where spinal fusion is concerned, the surgeon has several option for using bone graft material. For instance, the patient's autografted bone or locally harvested bone may be used. This could be a combination of bone from the spinal area under operation or from the hip bone. Alternatively, it could be allograft bone or from donated and prepared sources.
Complications after ACDF surgery:
Every surgery presents its own risks and complications, and so it is also with ACDF. The rate of risks and complications in this surgery vary and depend on a combination of these factors:
- The level of success with ACDF surgery
- Condition of the patient's vertebral disc, his overall physical condition, whether he is a smoker or not and other health factors
- Insufficient symptom relief post-surgery
- Bone graft healing does not take place to form a fusion
- Temporary or continuous swallowing or dysphasia
- Speech disturbances like hoarseness of voice from injury site to recurrent laryngeal nerve that supplies the vocal cords
- Spinal fluid leak
- Nerve root damage
- Damage to the spinal cord
- Major blood vessel injury
- Damage to the windpipe
- Airways being compromised due to hematoma
- Implants or devices and instrumentation may break or be dislodged, therefore necessitating another surgery.
- This surgery may not get rid of symptoms like tingling, pain, weakness or numbness. It could happen that bone spurs or disc material damage the nerves permanently. Besides, the longer a nerve has been irritated, the longer it will take to heal.
- Any complications arising from ACDF may also call for extra treatment that includes surgery or medication.
Post-surgery, you will feel the soreness of your incision soon after surgery. You will be sent to the recovery room where you will come to consciousness. Here, your vital signs will be checked and your condition observed. You might be kept here like most patients for about two to three hours after surgery. When your doctor is convinced that your condition is normal, you will be sent to your room in the hospital.
The nurses at the hospital will check from time to time to see if your vital signs are stable and that your nerves function normally. The day after hospital it is very likely that you will be discharged. Your doctor will decide the best course for you, post-operation, with the accent on your comfort and any other medical condition you may suffer from. Your doctor will advise you which medications to take for pain once you're back home, besides advising you on caring for your wounds, exercises, collar wear, physical therapy and any limitations on your activities.
When to call a doctor:
- If your temperature exceeds 101° F, or if the incision begins to separate or show signs of infection, such as redness, swelling, pain, or drainage.
- If your swallowing problems interfere with your ability to breathe or drink water.
Once the surgery is over, you should try to get out of bed and walk a little. If you don't do this but experience any issues with your recuperation later, it could be attributed to your lack of physical activity. Your doctor will decide the right time for you to go home after the surgery.
The Krishna Institute of Medical Sciences' Center for Advanced Orthopaedic Surgery, Secunderabad and Kondapur, is India's largest and most highly respected hospital with equal respect abroad too. A wide range of orthopaedic conditions are examined and treated here using the most ultra-modern surgery techniques and recuperative methods-- all done by experts in this field.
You might come in here for a simple surgery or a complicated one, but you will always leave with confidence at having come to the right place at the right time and putting yourself in the right hands.
Our hospitals aren't only centers of excellence in surgical and patient care but are also leading centres for research and development. We have many a spinal cord specialist in Hyderabad who can give you the right advice for your condition and restore you to good health. No wonder, after so many years of tireless service to the community, we are considered by our patients as the best spine hospital in hyderabad. We are deeply humbled by this honor and in fact, it has energized us to scale new heights in surgical and patient care.
We now aim to hold a coveted space among the nation's top spine surgery hospitals and we seek your patronage in this matter. Today, we can proudly claim to be the best hospital for neurology in Hyderabad, with our team of experts always at your service. To know more about the best spine surgery doctor in Hyderabad, come to us at KIMS.