Anterior Cervical Discectomy and Fusion (ACDF)
ACDF is a common spine operation in which a diseased cervical disc is removed through an anterior (front) approach to the neck and the resulting space is filled with a graft/implant to fuse two vertebrae together. The goal is to relieve disc and bony structures compressing a nerve root or the spinal cord.
Laatst bijgewerkt: 2026-06-08
Definition
Anterior Cervical Discectomy and Fusion (ACDF) is a surgery that reaches one or more cervical disc levels through an approach from the front of the neck. The diseased disc and, when present, accompanying bony spurs (osteophytes) are removed to relieve pressure on the nerve root and spinal cord. An interbody graft/cage is placed into the space left by the disc and is usually supported with a plate-and-screw system so that the two adjacent vertebrae fuse over time. The method is one of the most frequently used reference techniques in cervical degenerative disease.
Indications
ACDF is considered for cervical radiculopathy (arm pain, weakness) or myelopathy (spinal cord compression) caused by a cervical disc herniation or spondylotic stenosis demonstrated on imaging and concordant with clinical findings. It is generally offered for radiculopathy unresponsive to adequate conservative treatment or in the presence of progressive myelopathy. Progressive neurological loss, balance disturbance, or worsening hand dexterity may prompt earlier surgical evaluation. Suitability depends on the level of compression and the patient's overall condition.
Procedure
The procedure is performed under general anesthesia with the patient supine and the neck slightly extended. A small incision is made along an anterolateral skin crease; the muscle, vascular, and pharyngo-tracheal structures are gently mobilized to reach the front of the spine. The target level is confirmed with fluoroscopy. The disc is removed under the microscope or magnification, osteophytes are cleared when needed, and the spinal cord/nerve root is decompressed. An appropriately sized graft or cage is placed into the disc space; in most cases anterior fixation with a plate and screws is added. After confirming decompression, hemostasis is achieved and the layers are closed.
Advantages and Limitations
The anterior approach gives direct access to the disc and to compression coming from the front and generally disrupts less muscle than a posterior approach. There is long clinical experience and broad literature support. However, fusion eliminates motion at the treated level and may accelerate degeneration at adjacent levels over time; for this reason, motion-preserving disc replacement (arthroplasty) can be considered as an alternative in selected cases. Multilevel disease, poor bone quality, or marked deformity may change planning and require additional techniques.
Recovery and Risks
Most patients mobilize early; bony fusion may take weeks to months to complete, and activity is increased gradually during this period. Possible risks include temporary or permanent hoarseness, difficulty swallowing, infection, bleeding, cerebrospinal fluid leak, nerve or spinal cord injury, graft/implant displacement, and failure of fusion (pseudarthrosis). Adjacent-level disease may appear over the long term. No outcome is guaranteed; the decision is individualized by considering the patient's clinical status and imaging findings together.
Bronnen
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1283-1294.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:2830-2866.
- Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40-A(3):607-624.
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