ACDF means anterior cervical discectomy and fusion.
Fusion (arthrodesis) is a surgical technique in which two or more of the vertebrae of the spine are joined (fused) in such a way as to impede movement between them and reduce pain.
During surgery, a small amount of bone graft substitute (we no longer take a bone graft from the hip) is placed around the spine. Bone grafts consolidate after several months (similar to the consolidation of a fracture), which binds the vertebrae between them.
Cervical hernias that need surgery usually require not only removing the herniated disc (discectomy), but also fusion.
With this procedure, the disc is removed by an incision in the anterior part of the neck and a small artificial disc device is inserted. A cervical disc replacement involves the same surgical approach to an ACDF.
How is the fusion made?
There are many surgical approaches and methods to fuse the spine, and all of them include placing bone grafts between the vertebrae. In the neck, the anterior approach is more frequent.
The fusion usually includes the use of instrumentation (plates, screws, etc).
Instrumentation is sometimes used to correct a deformity, but it is generally used as an “Internal immobilizer” to maintain the vertebrae immobile while the bone graft consolidates.
The bone graft to be used can be taken from a bone in the same patient (autograft) or bone bank (allograft).
The allograft (bench bone) can be used as an alternative to the patient’s own bone, although the consolidation of the allograft is not as predictable as the patient’s own bone, but avoids having to take graft and therefore reduces pain.
Currently, synthetic alternatives are also used as bone graft substitutes with good results.
With some of the new “minimally invasive” surgical techniques, fusion can be done through smaller incisions. The indications for minimally invasive surgery are the same as with traditional surgery and it is important to take into consideration that they do not imply less risk regarding surgery but do offer much quicker recovery.
What are the risks of fusion?
-Infection in the wound or in the bones of the spine.
-Deep venous thrombosis.
-Damage to a spinal nerve, causing weakness, pain, loss of sensation and problems with the bowels or bladder.
How long does it take to recover from spinal fusion?
Recovery after spinal fusion is quicker than you expect with the minimally invasive techniques that we use. Patients usually remain hospitalised for 1 night, but often it may be a day case procedure.
It takes some time to return to normal activity after a spinal fusion since especially for some sports activities some evidence of bone consolidation must be seen before authorizing them.
The consolidation process after spinal fusion is similar to that which occurs after a fracture. In general, the first evidence of bone consolidation does not appear on radiographs until at least 6 weeks after surgery. However, the spine is usually stable for most activities a couple of weeks after the procedure.
The initial cost of surgery and medical devices per patient are higher than for other procedures. However, it is often a permanent solution to the underlying problem which means less additional costs in the future.
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