Anterior Cervical Discectomy and Fusion
Anterior Cervical Discectomy and Fusion surgery was introduced by Smith and Robinson in the late 1950’s as a means of removing a symptomatic herniated disc in the neck and using bone graft taken from the iliac crest (back of hip) to fuse the neck bones together. While this technique has been refined along with the development of new surgical instrumentation and implants, this surgical approach remains the gold standard.
The indications for this procedure include the presence of cervical disc disorders in which there is nerve root or spinal cord compression caused by disc herniation or bone spurring. Classically, these conditions cause neck pain with radiations to one or both arms including tingling, numbness, and/or weakness. While nerve compression can arise from a traumatic event, a fracture to the neck, or from a tumor, the most common cause of nerve root irritation (radiculopathy) is from degeneration associated with the aging process and normal wear and tear. Standard non-surgical treatments include physical therapy, injections, and medications are tried first. Failure to improve with non-surgical care or having the presence of an emergent condition such as a fracture, tumor, or profound weakness, may warrant surgical management.
The surgical technique involves making an incision over the front of the neck and dissecting the soft tissues down to the level of the spine. The affected disc(s) are identified and confirmed with x-rays. The disc material is then removed using delicate instruments. Any offending bony spurs are removed and all pressure is removed off of the nerves and/or spinal cord.
One the discectomy has been performed, there are different techniques and implants available to perform the fusion. The classic approach involves placing bone between the vertebral bodies. This bone can come from the back of the patients own hip (autograft) or from a cadaver (allograft). For a standard one, two, or three level fusion, allograft bone has become popular as the fusion rates are high with no concerns of prolonged discomfort from taking bone graft from the hip. Cages, made from various metals or from a material known as PEEK, are also an option in place of bone graft, based on surgeon preference.
A plate and screws (“instrumentation” or “hardware”) is commonly used to stiffen the spine to improve the chances of fusion.
This surgery has advanced to a point where many are able to have a one or two level fusion on an outpatient basis. Larger reconstructions are performed in a hospital setting.
Success rates for this surgery are among the highest of any spinal procedure performed. A one or two level anterior cervical discectomy and fusion has a success rate of over 90%. This refers to a reduction in pre-operative arm symptoms and return to function.
The general risks of this procedure include infection (superficial or deep), nerve injury, bleeding, adjacent level disease, hardware failure and risks associated with anesthesia.