ACDF surgery to remove discs, bone grafts, cervical spine fixation

ACDF surgery is a type of surgery that aims to remove a herniated or degenerative disc in the neck. Usually, this is a simple surgery and the patient can go home the same day.

ACDF stands for “an Anterior Cervical Discectomy and Fusion” and is performed to remove any discs located on the cervical spine, from the neck to the waist. Depending on the patient's specific condition and symptoms, doctors may remove more than 1 disc.
After the disc is removed, there will be space between the vertebrae. Therefore, to shape the cervical spine and prevent the vertebrae from collapsing and rubbing against each other, bone grafting will be carried out to fill this hollow space.
Bone grafts often act as a bridge between 2 vertebrae, creating spinal fusion. After about 3 to 6 months, the 2 vertebrae will be able to join together, forming a solid piece of bone and thereby effectively shaping the cervical spine.

As mentioned above, performing bone grafting after discectomy is necessary to shape the cervical spine. This bone pad can be obtained from many sources, each of which will have different advantages and disadvantages.
Autograft: the bone will come from the patient himself. The surgeon will remove bone cells from the hip (iliac crest). This form of bone graft will have a high rate of success because it has the cells as well as proteins for bone growth. However, patients may experience hip pain after surgery. Allograft: is bone from the outside (from another body). This type of bone will be taken from people who agree to donate organs after their death. The biggest disadvantage of this type of bone graft is that there are no cells or proteins left for bone growth. However, it still has certain effects in shaping the cervical spine. Artificial bone: Doctors can use synthetic resin or biosorbable compounds to form bone grafting materials for patients. After performing a bone graft, the patient may initially feel some discomfort in movement, and the naturalness of movement will depend on the adaptability of the graft.

Patients with degenerative disc disease: discs can wear out naturally, leading to inflammation of the joints. As the discs dry out and shrink, their cushioning properties become less flexible, leading to narrowing of the canal or herniated disc. The patient has a bulging and herniated disc. The patient had persistent and recurrent pain that did not respond to medical treatments more than 3 months after treatment. The patient has progressive neurological deficit. However, in some cases, ACDF surgery will be contraindicated:
Patients with disc herniation above 3 floors. Pre-existing neck infection. The condition of the multi-level cervical spinal canal is narrow.

The patient will be scheduled to have some preoperative tests, such as blood tests, electrocardiograms, chest X-rays... a few days before the surgery. Patients also need to fully declare all medications they are taking. Some of the following drugs need to be discontinued within 1-2 weeks to prepare for ACDF surgery:
All non-steroidal anti-inflammatory drugs such as Nuprin, Aleve, Naprosyn... Blood thinners . In addition, the pre-surgery lifestyle also needs to be adjusted: Do not smoke and drink alcohol 1 week before surgery. Do not eat or drink anything in the middle of the night before surgery. In particular, on the morning of ACDF surgery, patients need to:
Take a bath with Betadin or antibacterial soaps, wear thin, clean clothes. Leave all valuables and jewelry at home. Bring a list of the medications you are taking with the dosages. Bring a list of medications/food allergies.

Collar neck for 6-8 weeks until the cervical spine is solid and stable. After surgery, the patient will be treated with antibiotics for 5-7 days.

Esophageal damage Patients may experience some sensations of swallowing difficulty, difficulty swallowing, vomiting blood... in case of mild esophageal injury. More seriously, the patient may have a perforation of the esophagus. This is due to the fact that the doctor had rough scissors during the operation and cut into the esophagus.
Injury to the jugular vein, artery Due to not performing the correct dissection according to anatomical layers. The patient required carotid artery sutures and anticoagulation after surgery.
Damage to the recurrent nerve The most obvious manifestation of this complication is a hoarse voice, difficult to pronounce.
Tracheal Injury Similar to esophageal damage, tracheal damage after ACDF surgery is also caused by the doctor's rough pulling. To overcome, the patient needs to suture the tracheal perforation area and prolong intubation.
Overall, ACDF surgery is very effective in treating many diseases of the cervical spine. To ensure a successful surgery, the patient needs to strictly follow the instructions from the doctor.
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