Anterior cervical discectomy and fusion (ACDF)
An anterior cervical discectomy and fusion (ACDF) involves removing a damaged disc to relieve spinal cord or nerve root compression and alleviate corresponding pain, arm weakness, numbness, and tingling.
The surgery is performed through a small incision in the front of the neck. The disc is removed from between two vertebral bones, and any disc herniations or bone spurs that cause spinal cord or nerve root compression are removed as well. A fusion surgery is done at the same time as the discectomy operation in order to stabilize the cervical segment. A fusion involves placing bone graft and/or implants where the disc originally was in order to provide stability to the area.
Most anterior cervical discectomy and fusion operations can be performed on an outpatient basis, with patients returning home the same day or after a one night stay in the hospital.
The advantages of an ACDF operation include:
- Direct access to the disc and the spinal cord: The anterior approach allows direct visualization of the cervical discs, which are usually involved in causing the spinal cord or nerve compression and symptoms. Removal of the disc results in direct decompression of the affected nerve or the spinal cord.
- Less postoperative pain. Patients tend to have less incisional pain from this approach than from a posterior operation.
Cervical disc replacement
A cervical disc replacement is an alternative to anterior cervical discectomy and fusion in select patients. The goal of a cervical disc replacement is to remove spinal cord or nerve root compression, while maintaining neck motion. Artificial discs are designed with the goal of mimicking the form and function of the spine’s natural disc. This operation is typically performed for younger patients without significant neck arthritis, who have a cervical disc herniation causing significant neck and/or arm pain that has not responded to nonsurgical treatment options.
The most important advantage of a cervical disc replacement is maintenance of normal neck motion. This, in turn, eliminates additional demand from the other discs in the cervical spine, and is believed to reduce the risk of future disc breakdown at the other healthy discs. Also, a cervical disc replacement eliminates the potential issues associated with the need for a bone graft for spinal fusion, and allows for early postoperative neck motion.
It is important to remember that a disc replacement is a motion-preservation procedure and not a motion-creation procedure. This means that a severely arthritic disc that did not move before disc replacement is not likely to move after disc replacement. In fact, for patients with severe neck arthritis and neck pain in addition to arm pain, an anterior cervical discectomy and fusion is probably a more suitable surgical option.
Most cervical disc replacements can be performed on an outpatient basis, with patients returning home the same day or after a one night stay in the hospital.
Posterior cervical laminoplasty
A laminoplasty is a surgical procedure that enlarges the spinal canal. For patients with severe spinal cord compression at multiple levels, who also have normal neck alignment and minimal neck pain, a laminoplasty offers a motion-sparing technique for spinal cord decompression. Similar to the lumbar spine, the “lamina” creates a rigid “roof” over the spinal canal. During a laminoplasty, a hinge is created on one side of the lamina, and the other side is wedged open with the aid of a small metallic plate. This creates more room for the spinal cord without necessitating a fusion. Most patients will notice immediate relief of arm pain, and some improvement in hand numbness. A one or two night hospital stay is usually needed prior to going home. It is important to work on strengthening of the muscles of the back of the neck after a laminoplasty, and isometric cervical extensor strengthening is begun as soon as tolerated.
Posterior cervical foraminotomy
Posterior cervical foraminotomy is a minimally invasive procedure that involves removal of bone spurs or herniated disc material from the passageway of a nerve root through the foramen (latin for “hole”). The procedure is done under general anesthesia, and through a roughly 1-inch-long incision on the back of the neck. Precision instruments are used to carefully remove a small amount of bone which serves as the outer wall of the foramen. Once the foramen is opened, the nerve root can be seen. Then, the offending disc material or bone spurs are carefully removed under magnification, and the incision is closed with sutures. Most patients will note immediate and near complete relief of arm pain after surgery. No fusion is involved in this procedure, and most patients can undergo a cervical foraminotomy on an outpatient basis.
Posterior cervical laminectomy and fusion
The goal of a posterior cervical laminectomy and fusion is to remove compression of the spinal cord and achieve spinal stability. This operation is reserved for patients who have multi-level spinal cord compression and severe neck arthritis or instability of the cervical vertebrae, in whom surgery from an anterior (or front) approach is undesirable or not possible. A posterior cervical fusion alone can be performed for those with a nonunion (no healing) of a previous anterior cervical fusion.
This operation involves a 3-5 inch incision on the back of the neck. The lamina, or the bony roof of the spinal canal, is removed using precision tools to decompress the spinal cord. Then, small screws are placed into the vertebrae, and connected with rods to stabilize the spine in correct anatomic alignment. Bone graft is placed on the bony surfaces to allow them to fuse together, completing the operation. Most patients will notice immediate relief of arm pain, and some improvement in hand numbness immediately after surgery. As the fusion heals over the first few months after surgery, most patients notice a considerable decrease in their neck pain as well.
Most patients will need a two to three night stay in the hospital after this operation, and will need to wear a neck brace for about 6 weeks after surgery.