Anterior Cervical Decompression and Spine Fusion
Anterior Cervical Decompression. Herein cervical herniated disc can be removed through an anterior approach which is through the front of the neck. It allows the offending disc to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness, and tingling. Fusion Surgery is almost always done at the same time as the discectomy in order to stabilize the cervical segment. Hence, the combined surgery is commonly referred as an ACDF surgery, Anterior Cervical Discectomy and Fusion. This surgery is done to treat a symptomatic cervical herniated disc, to remove bone spurs (osteophytes) associated with cervical spinal stenosis and arthritis
& may also be done for cervical degenerative disc disease. ACDF may be done for one or more than one level of the cervical spine. An ACDF is done with an anterior approach, which gives –
Better access to the spine:The anterior approach provides complete access to almost the entire cervical spine, from the C2 segment at the top of the neck down to the cervicothoracic junction, which is where the cervical spine joins with the upper spine (thoracicspine).
Less post operative pain: Spine surgeons often prefer this approach because it provides access to the spine through a relatively uncomplicated pathway. All things being equal, the patient tends to have less incisional pain from this approach than from a posterior operation.
In this method only one thin vestigial muscle needs to be cut since skin incision is made in the front of the neck, because of which anatomic planes can be followed right down to the spine. Due to limited amount of muscle dissection the post operative pain is also limited. Though it doesn’t rule out potential risks and complications with ACDF surgery. Most patients face difficulty in swallowing for 2 to 5 days due to retraction of the esophagus during the surgery.
Also,not all ACDF surgeries are the same—there are a number of options and variables as part of the surgery that can play a role in how successful it is and impact the relative risks and potential complications.
- Anterior surgical approach: The skin incision is one to two inches horizontally either on the left or right side of the neck. The thin platysma muscle under the skin is then split along with the skin incision, and the plane between the sternocleidomastoid muscle and the strap muscles is then entered. Next, a plane between the trachea/esophagus and the carotid sheath can be entered.Flat layers of fibrous tissue, thin fascia covers
the spine which is dissected away from the disc space.
- Disc removal: Disc Space is inserted by a needle and Spine surgeon confirms his position with the help of a X-ray .With the correct disc position on X-ray, the fibrous ring around the disc which is outer annulus fibrosis & soft inner core of the disc i.e nucleus pulposus are cut & then appropriate portions of the disc are removed.Anterior cervical discectomy can be performed to remove most of the disc not all.
- Canal Decompression: Posterior longitudinal ligament is carried out from the front to back of a ligament .This ligament is gently removed to allow access to the spinal canal to remove any osteophytes, bone spurs, disc material that have extruded through the ligament, which may be part of spinal stenosis or osteoarthritis.An operating microscope or a magnifying loupes is used while this dissection is performed so as to aid with visualization of smaller anatomic structures.
- Cervical Fusion: The insertion of a bone graft into the evacuated disc space serves to prevent disc space collapse and promote a growing together of the two vertebrae into a single unit, with this “fusion”
preventing local deformity, kyphosis and serving to maintain adequate room for the nerve roots and spinal
cord.Once the cervical fusion heals together, one solid bone is formed in the space where the disc used to be. An anterior cervical fusion is almost always done as part of a cervical discectomy.
in one night. They recover within about 4 to 6 weeks, although fusion may take upto 18 months to fully set up. Therefore patient have to follow relevant activity restriction & just like any other surgery certain potential risk
& complications can be occurred . The rate of occurrence of these risks & complication depends on – condition of the disc, the patient’s physical condition bone strength, diabetes, etc whether or not the patient smokes, and other