Concept
Anterior cervical discectomy and fusion
Anterior cervical discectomy and fusion (ACDF) is a surgical procedure to treat nerve root or spinal cord compression by decompressing the spinal cord and nerve roots of the cervical spine with a discectomy, followed by inter-vertebral fusion to stabilize the corresponding vertebrae. This procedure is used when other non-surgical treatments have failed. ACDF is used to treat serious pain from a nerve root that has become inflamed. This can be caused by:
- a herniated disc when other non-surgical treatments have failed. The nucleus pulposus (the jelly-like center of the disc) of the herniated disc bulges out through the annulus (surrounding wall) and presses on the nerve root next to it.
- degenerative disc disease (spondylosis). The disc consists of about 80% water. When one grows older, the disc starts to dry out and shrink, causing small tears in the annulus and inflammation of the nerve root. Bone morphogenetic protein (rhBMP) should not be routinely used in any type of anterior cervical spine fusion, such as with anterior cervical discectomy and fusion. There are reports of this therapy causing swelling of soft tissue which in turn can cause life-threatening complications due to difficulty swallowing and pressure on the respiratory tract. The neurosurgeon or orthopedic surgeon enters the space between two discs through a small incision in front (= anterior) of and at the right or left side of the neck. The disc is completely removed, as well as arthritic bone spurs. The disc material, pressing on the spinal nerve or spinal cord, is then completely removed. The intervertebral foramen, the bone channel through which the spinal nerve runs, is then enlarged with a drill giving the nerve more room to exit the spinal canal. To prevent the vertebrae from collapsing and to increase stability, the open space is often filled with a graft. That can be a bone graft, taken from the pelvis or cadaveric bone; or an artificial implant. The slow process of the bone graft joining the vertebrae together is called "fusion".
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Spondylosis
Spondylosis is the degeneration of the vertebral column from any cause. In the more narrow sense it refers to spinal osteoarthritis, the age-related degeneration of the spinal column, which is the most common cause of spondylosis. The degenerative process in osteoarthritis chiefly affects the vertebral bodies, the neural foramina and the facet joints (facet syndrome). If severe, it may cause pressure on the spinal cord or nerve roots with subsequent sensory or motor disturbances, such as pain, paresthesia, imbalance, and muscle weakness in the limbs.
