Anterior Cervical Discectomy and Fusion (ACDF)

Cervical Spondylosis

Cervical is the medical term for neck. Spondylosis is a term referring to degenerative arthritis of the joints between the bones. Therefore cervical spondylosis is arthritis of the neck. The neck supports the head and when the neck is injured, you can feel like the ‘weight of the world is on your shoulders’. It can cause pain in the neck, radiating into the head, pain shooting down the arms and pain down the spine. It can lead to pressure on the nerves or the spinal cord. This can then cause numbness in the hands, legs and difficulty with walking. It can be so bad as to make a patient completely disabled.

The causes of common neck pains are as follows

·         Poor posture at home or at work leading to neck strain and muscle spasms

·         Cradling the phone between your neck and shoulder (without using your hand)

·         Neck injuries such as whiplash

·         Lying on your stomach to read for long periods

·         Degenerative diseases causing disc prolapse and arthritis

Treatment

·        Prevention of neck problems by avoiding the common causes as above

·        Neck exercises and physiotherapy (including massage and use of cervical collars) 

·        Using drugs as prescribed by the doctor (paracetamol and anti-inflammatory drugs)

And finally surgery

Surgery for cervical spondylosis can be either simple or complex. Simple operation includes simple epidural or nerve root injection performed carefully in theatre. This must be done under x-ray guidance to avoid the injection going into either the spinal cord or even the arteries in the neck.

The operation often prescribed is called an ANTERIOR CERVICAL DISCECTOMY. This can be done with or without fusion. Fusion entails putting either a bone graft from the person or an artificial implant in the space between the bones (after removing the disc, called a discectomy). This bone or implant allow the bones to fuse together in a solid manner within about 2-3 months. Sometimes doctors supplement the fusion and enhance it by putting a cervical plate and screws on the bones. This makes the neck solid and fixed immediately while waiting for the fusion to occur.

Below is a picture of a patient who has undergone the operation. This person has undergone an ADCF with iliac graft and a plate. The plate and screws are over the 4th and 5th bones in the neck. There are seven bones in the neck, of course.