ACDF is an operation to remove a damaged disc in the neck and fuse the vertebrae above and below it together. It is performed through the front of the neck to relieve pressure on the spinal cord or nerve roots, treating arm pain, numbness, weakness, and balance problems.
An incision is made in the front of the neck, typically in a skin crease. The neck muscles, trachea, and oesophagus are gently moved aside to access the spine. The damaged disc is removed, relieving pressure on the nerves or spinal cord. A cage filled with bone graft material is placed in the disc space, and a small plate and screws are fixed to the front of the vertebrae to hold everything in place while fusion occurs. The operation takes one to two hours.
ACDF is recommended for cervical disc herniation causing arm pain (radiculopathy) that has not responded to non-operative treatment, cervical spinal stenosis causing spinal cord compression (myelopathy) with symptoms such as balance problems, hand clumsiness, or leg stiffness, and certain cervical spine fractures.
Physiotherapy, pain medication including neuropathic agents, cervical epidural injection, activity modification, and time. Many disc herniations improve without surgery. Cervical disc replacement is a surgical alternative that preserves movement at the treated level.
Standard pre-assessment. CT and MRI scans for planning. Smoking cessation is critical — fusion failure rates are five times higher in smokers.
Up to 90% of patients experience significant improvement in arm pain. Symptoms of spinal cord compression may stabilise or improve, though recovery of established neurological damage is less predictable. The fused segment provides permanent stability.
Very common in the first few days after surgery due to oesophageal retraction. Usually resolves within one to two weeks.
Temporary voice changes from recurrent laryngeal nerve stretching. Usually resolves.
Some loss of neck rotation at the fused level. Usually well compensated by adjacent levels.
The bones may fail to fuse. Risk approximately 5–8% for single-level, higher for multi-level. Much higher in smokers.
Increased stress on levels above and below the fusion may cause new problems over time.
Persistent hoarseness from nerve damage. Permanent in less than 1 in 250 patients.
Risk approximately 1%. Could cause arm weakness, numbness, or in very rare cases, paralysis.
Tear in the dural membrane. Occurs in approximately 3% and usually heals.
Very rare injury to the food pipe.
Blood collection causing airway compromise. A surgical emergency requiring urgent drainage.
General anaesthesia. Neuromonitoring may be used to monitor nerve function during surgery.
Hospital stay of one to two days. A soft collar may be worn for comfort. Walking is encouraged immediately. Gentle neck exercises begin at two to four weeks. Return to desk work at two to four weeks. Driving when you can turn your head safely, usually at two to four weeks. Avoid heavy lifting for six to twelve weeks. Full fusion takes three to six months.
Wound check at two weeks. Surgeon review with X-rays at six weeks and three to six months to assess fusion. Long-term monitoring for adjacent segment disease.
A single-level fusion causes minimal noticeable loss of movement. Multi-level fusions may be more noticeable, but most patients adapt well.
Nicotine prevents bone growth and dramatically increases the risk of non-fusion. Stopping smoking is the single most important thing you can do to improve your outcome.
For suitable patients, cervical disc replacement preserves movement and may reduce adjacent segment disease. Not everyone is a candidate — your surgeon will advise.