Anterior Cervical Discectomy and Fusion - for nerve compression
An anterior cervical discectomy and fusion (or ‘ACDF’) is commonly performed to remove pressure on a nearby nerve or the spinal cord itself. Below are answers to common questions pertaining to this operation.
Where will my surgery be performed?
It will be performed at Forte Health or St Georges Hospital. We will advise you which facility and send out a preadmission pack for you to complete prior to your scheduled date.
Do I need to stop any medications prior to surgery?
Please advise if you are taking medications that affect your bleeding tendency (eg. aspirin, warfarin, clopidogrel, dabigatran and others (check with your family doctor)). These will need to be discontinued at least 5 day prior to surgery unless otherwise advised. Please contact (03)3660422 for further direction. Other medications should be taken as normal.
The Day of Surgery
How long prior to surgery do I need to avoid food or drink?
You will need to stop eating and drinking (other than water) 6 hours prior to your surgery. You should stop drinking water and chewing gum 2 hours prior to your surgery.
What type of Anaesthetic is given?
In all patients a general anaesthetic is given meaning you will be completely asleep throughout and will have no memory of the procedure.
How long will the operation take?
The surgery takes 60-120 minutes. You will be monitored in recovery until the effects of the anaesthetic wear off and will return to the ward ~1 hr later.
Where will my surgical scar/s be?
An incision is made on the front of your neck, to the right of midline, part-way between your chin and collar bone. Typically it is 5-7cm in length. If ‘bone graft’ is also needed a second wound (5-cm) is made over the right pelvic brim.
What are the risks of surgery?
While surgery has an excellent chance of successfully relieving your symptoms risks do exists.
- Wound infection
Signs of an infection include redness and/or discharge from the wound. Antibiotics are required. If severe an operation to surgically clean the area may be necessary. Neck wounds have a low rate of infection (<1%) while it is more common (2-3%) in the wounds around the hip used during bone grafting.
In rare circumstances (<1%) a haematoma in the neck wound may develop that causes swallowing and rarely breathing problems. A drain is inserted to help reduce this risk. If you develop any breathing difficulties after discharge this is an emergency – call 111.
- Difficulty Swallowing
The oesophagus is retracted during surgery and therefore it is common for people to experience difficulty swallowing post surgery. These symptoms normally resolve within the first few weeks and only rarely persist. Very rarely the oseophagus can develop a tear.
- Voice Changes
Occasionally patients wake up with a hoarse or ‘raspy’ voice that is typically transient and only rarely persists.
- Neurological Injury
Although the operation is performed near the spinal cord injury is extremely rare (<1/10,000) but at worse can leave patients paralysed.
How long will I stay in hospital?
It is expected you will require a one night overnight stay in hospital. Prior to discharge the drain/s inserted at the time of surgery will be removed. A prescription for pain relief and a medical certificate will be provided if required.
Will I need to wear a neck collar afterwards?
A soft foam collar will be provided. This is used for pain relief only and can be discarded at any stage.
How long do I leave the wound dressing/s on?
Each wound will be covered with two dressings. Directly on your wound will be a thin piece of perforated tape (‘mefix’). This should be left on until the 2-week visit or until it falls off spontaneously. The outer dressing (that has a clear edge and an absorbent center, called ‘opsite’) should cover the wound for at least 1 week. It may need to be changed if it gets wet or covered in blood. While it is OK to shower, after which the opsite may need to be changed (always leave the mefix on), avoid bathing or soaking the wounds for the first 2 weeks.
How fast will my symptoms recover?
While surgical pain in the neck is generally well tolerated the hip wound (when bone graft is needed) is typically the most painful part of the procedure. Pain from either surgical site should settle over the first few weeks.
When surgery has been performed to relieve pressure on a nerve that is causing arm symptoms these will improve the most within the first 3 months, however further improvement out to 12 months is expected. Arm pain tends to improve promptly (most within the first 6 weeks). Improvements in ‘numbness’ and ‘pins and needles’ take longer (months and even years). Even though surgery may relieve all pressure on the nerve variable degrees of permanent residual numbness may be noted and reflect irreversible damage that has occurred prior to surgery.
When will I be assessed following surgery?
The first post-operative appointment will be 2 weeks after your surgery. The aims of this visit are to check on your progress, assess the wound and to discuss your return to work strategy. A second visit is planned 6 to 8 weeks following surgery to ensure your recovery remains on track. A final visit at 6 months is commonly arranged to review x-rays that assess whether the operation site has solidly fused.
How much neck range of movement can I expect to lose?
It depends on where your surgery occurs. Typically this is in the middle and lower parts (C3-C7) of the neck and the relative amount of movement lost from fusing these levels is limited (~10% of total neck movement).
What should I be doing in the first few weeks following the operation?
You should avoid heavy physical manual work, contact sports and high risk activities (eg. horse riding, quad biking, mountain biking, surfing, climbing ladders). Otherwise it is safe to return to light duties, walking, office jobs and simple household chores.
When can I expect to return to work?
Most people with office jobs can return to work between 2-6 weeks post surgery. Often this will be part-time initially. For more manual jobs time off work is likely to involve a 6-10 week period.
When can I return to sporting activities?
While it will be OK to exercise in a controlled environment (eg. gym, pool) from 6-12 weeks post surgery, a delay of at least 6 months is necessary before considering a return to any potentially high impact activities (mountain biking, snow-boarding) or contact sports. Prior to this an x-ray to confirm the bones have healed together (‘fused’) will be required.
What else can I do to optimize my recovery?
Smoking is often associated with inferior outcomes after fusion surgery – it slows down the healing rate and can contribute to a situation where the two bones do not heal to each other (called a ‘non-union’). This can delay your recovery and your return to contact sports and heavy work and occasionally necessitates further surgery.