What is Anterior Cervical Discectomy?
There are three main types of anterior cervical discectomy surgeries. Anterior cervical discectomy (ACD) is a surgical procedure that involves removing a part or all of a damaged spinal disc through an incision in the neck.
- ACD does not involve placement of a bone graft.
- Anterior cervical discectomy and fusion (ACDF) is similar to ACD, but it does involve placement of a bone graft.
- The anterior cervical discectomy and fusion with instrumentation (ACDFI) technique is similar to ACDF but additionally involves the placement of a plate to help stabilize the cervical spine.
Indications for each different type of surgery should be discussed with a spinal surgeon depending on the type, location, and severity of the disc injury.
What is Anterior Cervical Discectomy Used For?
Anterior cervical discectomy (ACD), anterior cervical discectomy and fusion (ACDF), and anterior cervical discectomy and fusion with instrumentation (ACDFI) are all used to treat:
- chronic cervical spine osteoarthritis,
- cervical spine trauma,
- radiculopathy,
- cervical disc herniations,
- myelopathy,
- osteomyelitis,
- spondylosis,
- vertebral body tumors, and
- post-laminectomy kyphosis.
How Do Doctors Perform Anterior Cervical Discectomy?
Anterior cervical discectomy is performed under general anesthesia. For all three types of anterior cervical discectomy procedures:
- Patients are placed laying down on their back with their head extended
- Hands may be tied down to allow for easier access to the neck
- The area of the neck and chest are prepped with antiseptics
- An incision is made in the front of the neck, and the muscles and subcutaneous layers are carefully separated
- Deeper structures such as blood vessels, nerves, the airway, and esophagus are also carefully moved
- Once the damaged disc is located, it is removed
- If an ACDF or ACDFI procedure is being performed, a bone graft and/or hardware is placed
- Deep structures are moved back into normal position
- The incision is sutured closed
- After surgery, a cervical collar may be worn for up to 6 weeks
X-rays may be performed at follow-up intervals. If there are any complications from the surgery, a CT scan or MRI may be needed.
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What are Risks and Complications of Anterior Cervical Discectomy?
Prior to surgery, the surgeon will assess the risks for complications. Risk factors that can lead to increased complications include:
- Advanced age
- Smoking
- Low bone density (osteoporosis)
- Obesity
- Sleep apnea
- Carotid artery disease
Complications of anterior cervical discectomy include:
- Infection of surgical wound
- Infection of bone graft or around hardware
- Spinal cord injury
- Nerve root injury resulting in weakness
- Tears in the tissue around the spinal cord (dural tears)
- Cerebrospinal fluid leaks
- Hardware complications
- Screw loosening or breakage
- Plate breakage
- Plate movement
- Graft failure
- Neck-related complications due to frontal approach
- Damage to esophagus
- Problems swallowing
- Neck bleeding
- Airway complications and obstruction