ACDF (Anterior Cervical Discectomy & Fusion) Surgery

Introduction

Anterior Cervical Discectomy and Fusion (ACDF) is a surgical procedure performed to relieve spinal cord or nerve root pressure caused by a damaged disc or bone spur in the cervical spine. This surgery aims to alleviate symptoms such as pain, numbness, and weakness, and to restore stability to the spine.

Indications for ACDF Surgery

ACDF surgery is typically recommended for patients experiencing:

• Severe neck pain that radiates to the shoulders, arms, or hands
• Numbness, tingling, or weakness in the arms or hands
• Degenerative disc disease
• Herniated disc
• Spinal stenosis
• Bone spurs
• Failed conservative treatments such as physical therapy, medications, and injections

The Surgical Procedure

The ACDF surgery involves several key steps:

1. Incision

A small incision is made in the front of the neck, usually on the left side. This anterior approach provides direct access to the cervical spine with minimal disruption to the surrounding tissues.

2. Disc Removal

The surgeon carefully removes the damaged disc and any bone spurs that may be compressing the spinal cord or nerve roots. This process is known as a discectomy.

3. Fusion

To maintain stability and prevent future issues, the space left by the removed disc is filled with a bone graft. This graft can be obtained from the patient’s own body (autograft) or from a donor (allograft). In some cases, synthetic materials may also be used.

4. Placement of Hardware

A small plate and screws are used to secure the bone graft and promote fusion. This hardware helps to stabilize the spine while the bone graft heals and fuses with the surrounding vertebrae.

Recovery and Rehabilitation

Recovery from ACDF surgery varies depending on the individual’s overall health and the extent of the surgery. Patients can generally expect:

• Hospital Stay: Most patients stay in the hospital for one to two days following surgery.
• Pain Management: Post-operative pain is managed with medications, and patients are encouraged to follow a pain management plan provided by their healthcare team.
• Neck Brace: A neck brace or collar may be prescribed to support the neck and promote healing.
• Physical Therapy: Rehabilitation typically includes physical therapy to restore movement, strength, and flexibility to the neck and surrounding muscles.
• Follow-Up: Regular follow-up appointments are necessary to monitor the progress of the fusion and ensure proper healing.

Potential Risks and Complications

As with any surgical procedure, ACDF surgery carries potential risks and complications, including:

• Infection
• Bleeding
• Nerve damage
• Difficulty swallowing or speaking
• Failure of the bone graft to fuse (nonunion)
• Adjacent segment disease, where adjacent vertebrae develop similar issues

Benefits of ACDF Surgery

When successful, ACDF surgery offers several benefits, including:

• Relief from chronic neck pain and radiating arm pain
• Improved mobility and function
• Stabilization of the cervical spine
• Enhanced quality of life

Nursing Care of Patient with ACDF (Anterior Cervical Discectomy & Fusion) Surgery

Anterior Cervical Discectomy and Fusion (ACDF) surgery is a procedure aimed at relieving spinal cord or nerve root pressure in the cervical spine by decompressing the spinal cord and nerve roots. Postoperative nursing care is critical to ensure optimal recovery, manage complications, and improve patient outcomes.

A. Postoperative Nursing Care

Immediate Postoperative Care

• Monitoring Vital Signs: Regular monitoring of blood pressure, heart rate, respiratory rate, and temperature to detect early signs of complications such as infection or bleeding.
• Pain Management: Administer prescribed analgesics to manage pain effectively. Assess pain levels frequently and adjust pain management strategies as needed.
• Neurological Assessments: Regularly check the patient’s neurological status, including sensation, motor function, and reflexes, to identify any changes or deterioration.
• Incision Site Care: Inspect the surgical site for signs of infection, such as redness, swelling, or discharge. Maintain a clean and dry dressing as per the surgeon’s instructions.
• Respiratory Care: Encourage deep breathing exercises and use of an incentive spirometer to prevent atelectasis and respiratory complications. Monitor for signs of respiratory distress.

Mobility and Positioning

• Early Mobilization: Assist the patient in gentle movements and ambulation as soon as it is safe, to prevent complications such as deep vein thrombosis and enhance recovery.
• Proper Positioning: Ensure the patient maintains proper cervical alignment. Use of a cervical collar may be recommended to provide additional support and stabilization.
• Activity Restrictions: Educate the patient on activity limitations, such as avoiding heavy lifting, bending, or twisting, to prevent strain on the surgical site.

Nutrition and Hydration

• Swallowing Assessment: Evaluate the patient’s swallowing ability before resuming oral intake, as ACDF surgery can impact swallowing functions.
• Hydration: Ensure adequate fluid intake to prevent dehydration and facilitate healing.
• Nutritional Support: Provide a balanced diet rich in protein, vitamins, and minerals to promote tissue repair and recovery.

Patient Education and Support

• Discharge Instructions: Provide comprehensive discharge instructions, including wound care, medication regimen, activity restrictions, and signs of complications to watch for.
• Follow-Up Care: Schedule follow-up appointments with the surgeon to monitor progress and address any concerns.
• Emotional Support: Offer emotional support and counseling to help the patient cope with the stress and anxiety associated with surgery and recovery.

Potential Complications

While ACDF surgery is generally safe, it is crucial to be vigilant for potential complications, including:

• Nerve damage
• Difficulty swallowing or speaking
• Failure of the bone graft to fuse (nonunion)
• Adjacent segment disease, where adjacent vertebrae develop similar issues

REFERENCES

1. American Academy of Orthopaedic Surgeons. Cervical Radiculopathy (Pinched Nerve) (https://orthoinfo.aaos.org/en/diseases–conditions/cervical-radiculopathy-pinched-nerve/#:~:text=Cervical%20radiculopathy%2C%20commonly%20called%20a,as%20muscle%20weakness%20and%20numbness.). Last reviewed 8/2020.
2. Strenge KB, Heller JE, Williams DM, Slee AE, Summerside EM et al Three-level Anterior Cervical Discectomy and Fusion with or without an Investigational Posterior Stabilization System Assessed through 24 Months: A Multi-Center Randomized Controlled Trial. Spine (Phila Pa 1976). 2025 May 7. doi: 10.1097/BRS.0000000000005387. Epub ahead of print. PMID: 40331720.
3. Asada T, Subramanian T, Araghi K, et al. Comparison of Clinical Outcomes Between Anterior Cervical Discectomy and Fusion and Cervical Disc Replacement for Predominant Neck Pain. Global Spine Journal. 2025;0(0). doi:10.1177/21925682251338799
4. American Academy of Orthopaedic Surgeons. Cervical Radiculopathy: Surgical Treatment Options. https://orthoinfo.aaos.org/en/treatment/cervical-radiculopathy-surgical-treatment-options/. Last reviewed 8/2020.
5. Babici D, Johansen PM, Miller TD, et al. Five-Level Anterior Cervical Discectomy And Fusion.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8714041). Cureus. 2021 Nov;13(11):e19961.
6. Buttermann GR. Anterior Cervical Discectomy and Fusion Outcomes over 10 Years: A Prospective Study.(https://pubmed.ncbi.nlm.nih.gov/28604488). Spine. 2018 Feb;43(3):207-214.

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