Anterior cervical discectomy and fusion (ACDF)

Changed by Frank Gaillard, 5 May 2018

Updates to Article Attributes

Body was changed:

Show markup changes

Anterior cervical discectomy and fusion (ACDF) is a commonly performed spinal fusion procedure for the decompression of the cervical cord due to disc protrusions and posteriorly projecting osteophytes.

Technique

The procedure is carried out via an anterolateral neck incision with surgical approach passing between the aerodigestive tract (trachea, oesophagus, pharyngeal muscles) medially and the carotid neurovascular bundle (carotid artery, internal jugular vein, vagus nerve) laterally ².

The intervertebral disc is then resected along with the fibrocartilage covering the adjacent vertebral endplates (to allow for eventual osseous fusion). It is possible to reach back to the posterior longitudinal ligament, removing osteophytes and disc protrusion as well and extending laterally to decompress the neural exit foramina ^1,2.

Once decompression has taken place an interbody spacer of some kind is introduced. This can be in the form of ¹:

bone
- autogenous bone graft (e.g. from the anterior iliac crest of the patient harvested at the same time as the fusion is performed)
- allogenic bone graft (e.g. from cadaveric iliac bone or fibula)
- animal allogenic bone graft (e.g. bovine or calf)
synthetic usually packed with cancellous autobone, demineralized bone matrix or ceramics
- plastic
- metal (e.g. titanium or stainless steel)
- ceramic

Following this, a plate with screws that pass into the vertebral bodies above and below the operative segment is usually introduced to provide additional stabilisation ¹.

Newer devices combine screw fixation and interbody spaced into the one device, fitting entirely within the interbody space without the added bulk of the anterior plate ¹.

Complications

Although the procedure is generally safe a number of complications are encountered including:

intraoperative complications
- oesophageal perforation
- damage to the carotid artery or internal jugular vein
immediate postoperative complications
- dysphagia due to plate and screws
- hoarse voice due to damage to the recurrent laryngeal nerve
delayed complications
- adjacent segment degeneration
- adjacent level ossification

-Anterior cervical discectomy and fusion (ACDF) is a commonly performed <a title="Spinal fusion" href="/articles/spinal-fusion">spinal fusion</a> procedure for the decompression of the cervical cord due to disc protrusions and posteriorly projecting osteophytes. <h4>Technique</h4>The procedure is carried out via an anterolateral neck incision with surgical approach passing between the aerodigestive tract (trachea, oesophagus, pharyngeal muscles) medially and the carotid neurovascular bundle (carotid artery, internal jugular vein, vagus nerve) laterally 2.The intervertebral disc is then resected along with the fibrocartilage covering the adjacent vertebral endplates (to allow for eventual osseous fusion). It is possible to reach back to the posterior longitudinal ligament, removing osteophytes and disc protrusion as well and extending laterally to decompress the neural exit foramina 1,2. Once decompression has taken place an interbody spacer of some kind is introduced. This can be in the form of 1: <ul>
+Anterior cervical discectomy and fusion (ACDF) is a commonly performed <a href="/articles/spinal-fusion">spinal fusion</a> procedure for the decompression of the cervical cord due to disc protrusions and posteriorly projecting osteophytes. <h4>Technique</h4>The procedure is carried out via an anterolateral neck incision with surgical approach passing between the aerodigestive tract (trachea, oesophagus, pharyngeal muscles) medially and the carotid neurovascular bundle (carotid artery, internal jugular vein, vagus nerve) laterally 2.The intervertebral disc is then resected along with the fibrocartilage covering the adjacent vertebral endplates (to allow for eventual osseous fusion). It is possible to reach back to the posterior longitudinal ligament, removing osteophytes and disc protrusion as well and extending laterally to decompress the neural exit foramina 1,2. Once decompression has taken place an interbody spacer of some kind is introduced. This can be in the form of 1: <ul>
~~-<li><a title="adjacent segment degeneration" href="/articles/adjacent-segment-degeneration">adjacent segment degeneration</a></li>~~
~~-<li><a title="adjacent level ossification" href="/articles/adjacent-level-ossification">adjacent level ossification</a></li>~~
+<li><a href="/articles/adjacent-segment-degeneration">adjacent segment degeneration</a></li>
+<li><a href="/articles/adjacent-level-ossification">adjacent level ossification</a></li>

References changed:

1. Song KJ, Choi BY. Current concepts of anterior cervical discectomy and fusion: a review of literature. (2014) Asian spine journal. 8 (4): 531-9. <a href="https://doi.org/10.4184/asj.2014.8.4.531">doi:10.4184/asj.2014.8.4.531</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25187874">Pubmed</a>
2. Edward C. Benzel. Spine Surgery 2-Vol Set. (2012) <a href="https://books.google.co.uk/books?vid=ISBN9781455723324">ISBN: 9781455723324</a>

Systems changed:

Spine

Images Changes:

Image 1 X-ray (Lateral) ( create )

ADVERTISEMENT: Supporters see fewer/no ads

{"current_user":null,"inclusions":[{"imageId":14232547,"studyId":40109,"caseSlug":"anterior-cervical-discectomy-and-fusion-acdf-1","caption":"Case 1","thumbnail":"https://prod-images-static.radiopaedia.org/images/14232547/e25401e01711f0e750c71c88eed9d19a877facdffbf5211c08e7fe9732443bba_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":39233935,"studyId":68338,"caseSlug":"intervertebral-disc-space-cage","caption":"Case 2","thumbnail":"https://prod-images-static.radiopaedia.org/images/39233935/81d738b2a8dd58dff956ac3ee8ccda_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":39263233,"studyId":68369,"caseSlug":"intervertebral-disc-space-cage-1","caption":"Case 3","thumbnail":"https://prod-images-static.radiopaedia.org/images/39263233/2a1008230ccdf320ab62ad89a8cbff_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":40256949,"studyId":69149,"caseSlug":"facet-joint-fracture-treated-with-acdf-and-follow-up","caption":"Case 4","thumbnail":"https://prod-images-static.radiopaedia.org/images/40256949/2dc541aa28e99837f845f6dd127354_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":45431509,"studyId":74574,"caseSlug":"normal-cervical-disc-replacement-and-anterior-cervical-discectomy-and-fusion-acdf","caption":"Case 5: ACDF and adjacent cervical disc replacement","thumbnail":"https://prod-images-static.radiopaedia.org/images/45431509/67147447ec3ecb4e2c1a55f9c6a694_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":54818870,"studyId":105272,"caseSlug":"peek-cervical-cage-fusion-1","caption":"Case 6: PEEK cervical cage fusion","thumbnail":"https://prod-images-static.radiopaedia.org/images/54818870/0._big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":57389395,"studyId":118566,"caseSlug":"peek-cervical-cage-fusion-3","caption":"Case 7: with PEEK cervical cage fusion","thumbnail":"https://prod-images-static.radiopaedia.org/images/57389395/0._big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"}],"ddx_inclusions":[],"lang":"us"}

Updating… Please wait.

Unable to process the form. Check for errors and try again.

Thank you for updating your details.

Anterior cervical discectomy and fusion (ACDF)

Updates to Article Attributes

Technique

Complications

Image 1 X-ray (Lateral) ( create )

Articles

By Section:

By System:

Cases

Radiopaedia.org