Anterior Cervical Discectomy and Fusion (ACDF)

and Cervical Corpectomy

 

Operation
Also known as ACDF,  Corpectomy, Partial Vertebrectomy

Indication

Cervical Radiculopathy (arm pain caused by neck nerve entrapment/compression)

and Cervical Myelopathy (arm and leg pain and weakness plus poor balance due to compression of the spinal cord in the neck)

Pre-assessment
Yes

Pre-operative questionnaire
Click here

Special preparation for surgery
You will be advised when to stop the following medications:

blood thinning drugs including aspirin, warfarin, clopidogrel, HRT and oral contraceptives and some herbal medicines.

Admission to hospital
On the day of surgery

General anesthetic
Yes

Operation position
Supine (on back)

Details of operation
An incision is made to the left or right of the midline of the front of the neck usually using a skin crease. Approach is made to the spine by retracting (holding out of the way) the soft tissue structures of the front of the neck( blood vessels swallowing and breathing tubes). Special self retaining spinal retractors are used to gain a safe corridor down which to access the disc and vertebral body. The disc material is removed with specialised instruments. A spinal cage is inserted in to the cleared disc space. Then a plate can be applied to the front of the bone and secured to the bone with special screws. Alternatively screws are inserted directly through some cages. In some incidences the cage is secure enough to require no means of fixation to the bone.An X-Ray image is taken to show the cage and plate in position. If more than one disc is being operated on then another cage is inserted to that disc.

In the corpectomy operation a high speed bur is used to fashion a trough shape out of the bone and allow safe access to the spinal canal to remove bone and soft tissue from where it is compressing the spinal cord or spinal nerves. A larger cage is required to be put into the trough and secured with a plate and screws.

Length of surgery
1.5 – 3 hours

Urinary catheter required
Yes (occasionally in a multilevel ACDF or a corpectomy operation)

Post-operative drain required
No (occasionally in a multilevel ACDF or a corpectomy operation)

Post-operative antibiotics
Yes

Post-operative iv fluids (drip)
Yes- intravenous fluids and patient controlled analgesia

DVT prophylaxis
Yes – details tailored to individual patient

Mobilization after surgery
6 to 12 hours

Length of stay in hospital
1- 2 days

Post hospital recovery
2 weeks of gentle rest followed by 2 weeks gradually increasing to normal daily activities and a further 2 weeks of increasing to full activity level. Leave strenuous activities until after 6 weeks.

Sutures removed
Dissolvable

Dressing
Dissolvable glue

Review appointment
6 weeks with x-ray

4-6 months with x-ray

Physiotherapy
Yes mainly self exercise programme

Return to driving
2-4 weeks

Return to work
4- 6 weeks