As we age, the cervical disks in our spine begin to collapse and bulge, which causes a loss of space between cervical vertebrae. Cervical disk degeneration happens to everyone, usually by age 60, but some experience worse degeneration than others. Scientists aren’t sure why it happens, but for those with advanced cervical disk degeneration, surgery may be needed.
In some cases, disks are damaged due to injury instead of degeneration.
The cervical spine is made up of seven bones or vertebrae stacked one on top of another forming the neck. In between the vertebrae are cushions called disks. These act as shock absorbers so when they deteriorate with age, the neck can become painful and hard to move. Loss of mobility with cervical disk degeneration is common.
Because the upper part of the spinal cord passes through the cervical spine, the vertebrae or cervical disk can press on it when the opening becomes too narrow. Sometimes, the body reacts to a disrupted disk by forming bone spurs, which can also put pressure on the spinal nerves, causing pain. Pushing against the spinal nerves leads to pain, numbness and sometimes weakness in the neck and extremities. When nonsurgical treatments do not provide relief, surgery is often recommended.
Anterior Cervical Disectomy Fusion, or ACDF, treats nerve root or spinal cord compression through spinal cord and nerve root decompression. The goal is to stabilize the surrounding vertebrae where the disk has deteriorated. In most cases, a nerve root becomes inflamed because the disk has herniated allowing the jelly-like center of the disc to bulge through and put pressure on the nerve root or because the disc has degenerated and the cushion is no longer there to protect it.
During the surgery, the surgeon will make incisions on the front and right and left sides of the neck in order to enter the space between the two vertebrae. Then, the damaged disk as well as any bone spurs that have occurred in the area as a result of the body reacting to the disrupted disk will be removed. A drill is used to widen the opening the spinal cord runs through to eliminate pressure it was putting on the spinal cord and nerve roots. The vertebrae are then fused using a bone graft, often taken from the patient’s pelvis but sometimes a cadaver bone is used instead. If more than one disc has been damaged or if more stabilization is needed, a titanium plate or screws may be used to reinforce the vertebrae. This can help reduce neck pain after surgery as well as speed up recovery. In most cases the surgery is completed in one to two hours, however, it can take longer in some cases, especially when more than one disc must be removed. The surgeon should be able to provide a more accurate time measurement for the procedure based on the individual’s needs.
Recovery is gradual and often takes up to six weeks. One to three days of that recovery will be done in the hospital or clinic where the surgery was performed. Using an endoscopic micro discectomy instead can reduce recovery to just a couple of days. To maintain proper spinal alignment and prevent injury from too much movement, a neck brace is often recommended for up eight weeks post-surgery. To strengthen the muscles in the neck, physical therapy as well as massage and acupuncture may be recommended.
The goal of ACDF surgery is to eliminate pain caused by a pinched nerve or several pinched nerves in the neck or cervical spine. ACDF surgery is often recommended over other procedures if arm pain caused by a pinched nerve root is a main concern. Only about half of patients will feel reduced neck pain after the procedure.
ACDF surgery is done to alleviate severe symptoms associated with cervical disk degeneration, which include: neck stiffness, neck pain, headache, pain that travels into the shoulders and arms, weakness in hands, arms, shoulders and legs and numbness in the arms. Those who experience severe arm pain are often the best candidates for ACDF surgery.
When several vertebrae are fused together, a decrease in mobility may be experienced. You may be able to feel the difference with only one fusion in some activities that require a lot of neck movement. Most, however, do not experience a significant change in movement and many actually report better movement after surgery. When vertebrae are fused together, motion is eliminated in that part of the spine, which can lead to faster degeneration of surrounding disks and require subsequent surgeries. Other risks include blood loss, which could require the need for a blood transfusion, difficulty swallowing, a hoarse voice, infection, nerve damage, spinal cord damage, procedure failure (occurring in 1 in 50 cases) and failure to relieve symptoms.
After surgery it is important to get up and move as soon as possible to avoid complications from extended bed rest including risk of deep vein thrombosis (blood clots in the deep veins) and bed sores.
ACDF surgery is done to relive neck pain, arm pain and numbness or weakness in the neck and extremities caused by a pinched nerve.
Before surgical intervention, most patients will try a mix of physical therapy and pain medication to alleviate symptoms associated with degenerative disk disease. In some cases, steroid injections will be given in the spine or traction will be done to reduce symptoms. Other surgical methods include cervical total disk replacement surgery (a newer procedure during which an artificial disc is placed in the space between the vertebrae where the old one was removed). Posterior discectomy and lamino-foraminotomy are also surgical options for treating cervical disc degeneration.
Costs for ACDF often run $11,000-$25,000. Who treats you as well as where the surgery is performed will affect the final cost, as will how many discs are treated. Insurance will likely cover some or all of the procedure costs, so check with your provider for an accurate estimate of out of pocket expenses. Don’t forget to factor in aftercare, including physical therapy.
North American Spine Society (February 2013), “Five Things Physicians and Patients Should Question”, Choosing Wisely: an initiative of the ABIM Foundation, North American Spine Society, retrieved 25 March 2013
“Costs for Spinal Fusion Vary Substantially by Region, Shows New Research.” News-Medical.net. September 02, 2015. Accessed May 01, 2018. https://www.news-medical.net/news/20150902/Costs-for-spinal-fusion-vary-substantially-by-region-shows-new-research.aspx. https://intermountainhealthcare.org/ext/Dcmnt?ncid=520444815
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