ANTERIOR CERVICAL MICRODISCECTOMY & FUSION (ACDF)
Anterior Cervical discectomy and fusion (ACDF) is performed for cervical disc prolapse/ herniation that is causing symptoms, commonly neck and arm pain, and numbness or weakness of the limbs due to pressure on the cervical spinal cord or the nerve roots arising from it.
This surgery involves an incision over the front of the neck, using a skin crease so as not to be apparent later, gentle dissection is carried out to develop a plane between the carotid artery on one side and the trachea and esophagus on the other, to reach the front (anterior part) of the spine. The disc is then removed piecemeal under microscopic magnification till the dura (covering of the spinal cord) is reached and decompressed.
The gap thus created between the vertebral bodies is then filled by a graft or artificial disc. This may be a block of bone taken from the iliac crest of the hip, but increasingly over the last 15 years, spine surgeons have used implants made of titanium or PEEK either on their own or reinforced by an anterior cervical plate.
The surgery has 2 parts:
Anterior cervical discectomy: The first part is removing the offending disc compressing the spinal cord and nerves.
Fusion or Artificial cervical disc replacement: Fusion involves filling the gap between the vertebral bodies, created by the disc removal, by bone graft or more commonly by a bone chip filled implant made of titanium or PEEK. This intervertebral disc space implant may be supplemented by an anterior cervical plate for extra strength, particularly in cases of traumatic disc herniation.
Alternatively discectomy can be followed by an artificial cervical disc replacement.
CASE STUDY 1
A 46 years old lady with a history of neck pain with left arm pain and numbness for two months.
Procedure - C5-C6 anterior cervical microdiscectomy and fusion using PEEK cage.
Pre-op MRI (arrow points to the herniated disc at C5/6)
Post –op X-ray (Encircled - PEEK cage inserted in the disc
space after discectomy)
CASE STUDY 2
A 71 old gentleman, was admitted with complaints of difficulty in walking and standing and weakness of right grip since a fall. He was investigated with MRI of the cervical spine which revealed a C5-C6 disc prolapse and antero-listhesis and myelomalacia of the cord at that level.
Procedure - C5-C6 anterior cervical microdiscectomy and stabilization using PEEK cage and anterior cervical plate.
Pre-op MRI: (Encircled- disc herniation and signal changes in
Post op X-ray (Encircled - cervical plate over a PEEK cage)