Do you sometimes feel a sharp pain that goes from your neck down to your arms, or numbness in your fingers? Maybe you even feel a little unsteady when you walk. The cause of these things can be a pinched nerve in the cervical spine. So, today we are going to talk about a very successful surgery for this condition. This is called ACDF surgery.
What exactly is ACDF surgery?
Simply put, ACDF is an acronym for the long words "Anterior Cervical Discectomy and Fusion" . Let's understand this in Sinhala.
- Anterior Cervical means 'from the front of the neck.' This means that this surgery is performed from the side of the throat.
- Discectomy means 'removal of a disc'. This is the jelly-like part of our spine between two bones. It can bulge out and press on a nerve.
- Fusion means 'fusion'. It involves placing a bone graft in the place where the removed disc was, fusing the two vertebrae above and below together to form one strong bone.
So, the whole point is to go through the front of your neck, remove the problematic disc, and fuse those two vertebrae together. This is to relieve any compression of your spinal nerves or spinal cord in your neck.
Who is this surgery recommended for?
Because this is a major surgery, doctors only do it after all other treatments have failed. If you have the symptoms below and they don't improve with standard treatments, your doctor may consider this surgery.
| Symptom | Description |
|---|---|
| Pain that travels down the arm | A pain that feels like an electric shock from the neck, through the shoulder, down the arm to the fingers. |
| Numbness in hands and fingers | Tingling or numbness in the hands and fingers. |
| Weakness in the hands | Things like not being able to hold something firmly with your hand, things falling to the ground. |
| Loss of balance when walking | Feeling like you're going to lose your balance and fall while walking. |
| Severe neck pain | Severe neck pain that does not subside despite taking medication or resting. |
But remember, these symptoms do not necessarily require surgery. Your doctor will first try to manage the condition with physical therapy, medications, and possibly epidural steroid injections.
Surgery is only considered if those things don't help. The final decision on whether surgery is needed or not is made by your spine specialist.
How do you prepare before surgery?
There are a few things you need to prepare for before surgery.
- Meeting with the doctor: You will need to meet with your surgeon before the surgery. He or she will examine you and ask you about your health and any medications you are taking.
- Necessary tests: If you haven't had a neck X-ray or MRI scan, they will be ordered. These will help determine the exact location of the problem and its severity.
- Quitting bad habits: If you smoke, you should stop completely at least a month before the surgery. Smoking significantly delays bone healing. You will also be asked to stop drinking alcohol.
- Blood thinners: If you are taking blood thinners, you will need to stop taking them a few days before your surgery, as directed by your doctor. Do not stop taking any medication without your doctor's advice.
- Someone to take you home: It is essential to arrange in advance for someone to take you home after surgery.
How is the surgery done?
Okay, now let's see what happens during the surgery. Don't worry, you will be under general anesthesia so you won't feel any pain. You will be sound asleep.
1. Making the incision: While you are completely asleep, the surgeon will make a small 1-2 inch incision in the front of your neck, usually along the nape of the neck.
2. Reaching the spine: Then, very carefully, your trachea and esophagus are moved to one side and the spine is reached.
3. Disc Removal: Next, the problematic disc that is pressing on the nerve and the unwanted bone spurs that have formed around it are completely removed.
4. Fusion: Now comes the most important part. A bone graft or a small titanium cage filled with bone powder is inserted into the space where the disc was removed. This causes the two vertebrae above and below to fuse together over time, forming one strong bone. Just like a broken arm fuses.
5. Fixation: To keep these bones from moving until they are properly aligned, they are often fixed with a small metal plate and screws.
6. Closing the incision: Finally, everything that was done on that side is put back in place, and the incision is closed and sewn.
This entire surgery usually takes about 1-2 hours.
What happens after the surgery? How is the recovery time?
After the surgery, you will be taken to an observation unit. Your condition will be closely monitored until you regain consciousness. In most cases, you will only have to stay in the hospital for one night.
These things are important in healing:
- Painkillers: The doctor will prescribe painkillers for the pain in the first few days.
- Rest: You should get plenty of rest for the first few weeks. You should completely stop lifting weights and doing things that put strain on your neck.
- Neck Brace: Sometimes, you may be asked to wear a special brace to support your neck. You should wear it for as long as your doctor recommends.
- Physical therapy: 4-6 weeks after surgery, you will be instructed to do exercises under the supervision of a physiotherapist to strengthen the neck muscles.
It may take 6 to 12 months for the bone to fully heal and become strong. But you can gradually get back to your normal activities. Depending on your job, you may be able to return to work within 3-6 weeks, with your doctor's approval.
Are there any risks to this surgery?
As with any surgery, there are some risks involved. However, these are rare. The success rate is as high as 85%-95%. Here are some of the possible complications.
| Possible complication | A simple explanation |
|---|---|
| Difficulty swallowing | This is common in the early stages. It usually goes away after a few days. |
| Infections and bleeding | Risks that may arise in any surgery. |
| Nerve damage | This is a rare occurrence. Changes in voice and weakness in one arm may occur. |
| Bone fusion does not occur. | This risk is especially high in people who smoke. |
| If you experience these symptoms after surgery, tell your doctor immediately: | |
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Take-Home Message
- ACDF is a very successful surgery for symptoms caused by nerve compression, such as neck pain and numbness in the hands.
- Although this is a major surgery, you can have a very good recovery if you follow the proper instructions.
- Complete abstinence from smoking is extremely important for the success of the surgery.
- During the recovery period, follow the instructions given by your doctor and physical therapist exactly.
- If you have any questions or concerns about the surgery or the recovery period, don't be afraid to talk to the doctor.
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