Anterior Cervical Discectomy and Fusion (ACDF)

When a damaged disc in the neck is pinching a nerve or pressing on the spinal cord, an ACDF can often correct the problem, relieving arm pain and protecting the spinal cord. It is one of the most successful and well-studied operations in spine surgery.

What Is an ACDF?

ACDF stands for anterior cervical discectomy and fusion. “Anterior” means the surgery is done from the front of the neck, “cervical” refers to the neck, “discectomy” means removing the disc, and “fusion” means joining two vertebrae so they heal into one solid bone.

During an ACDF, the damaged disc and any bone spurs or disc fragments pressing on a nerve or the spinal cord are removed. This creates more space and relieves the source of your symptoms. A spacer filled with bone graft is then placed in the empty disc space to restore its normal height, and a small plate and screws are usually placed on the front of the spine to hold everything steady while the bones heal together over the next several months.

Watch Dr. Grunch explain what an ACDF is:

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Dr. Grunch explains: what is an ACDF?

Who Needs an ACDF?

• Arm pain, numbness, tingling or weakness from a pinched nerve (cervical radiculopathy) that hasn’t improved with conservative care
• Spinal cord compression (cervical myelopathy) causing clumsy hands, trouble with buttons or handwriting, or poor balance
• A herniated disc, bone spurs from cervical spondylosis, or disc degeneration at one or more levels
• Instability or arthritis that makes a fusion a better choice than a disc replacement

For some patients with healthy facet joints and good bone quality, a cervical disc replacement may be an option that preserves motion. Dr. Grunch performs both and will help you decide which is best for you.

Call 911 or go to the nearest emergency room if you have sudden weakness in your arms or legs, sudden trouble walking, or new trouble controlling your bladder or bowels.

Treatments to Try First

• Physical therapy: neck and upper back strengthening, posture work and traction
• Medications: anti-inflammatory medications, short courses of oral steroids or nerve pain medications
• Injections: cervical epidural steroid injections or nerve root blocks

When these don’t bring lasting relief, or there is weakness or spinal cord compression, surgery can often correct the problem.

How an ACDF Is Done

1. Anesthesia and monitoring: You’ll be fully asleep, lying on your back. Nerve monitoring may be used to protect the spinal cord and nerves.
2. A small incision: Dr. Grunch makes a small horizontal incision in a natural skin crease on the front of the neck.
3. Gentle access: The windpipe and esophagus are gently moved aside through a natural space between the muscles.
4. Removing the disc: Using a microscope, the disc is removed along with bone spurs and fragments pressing on the nerves or spinal cord.
5. Placing the spacer: A spacer filled with bone graft is placed in the disc space to restore its height and open up the nerve passages.
6. Stabilizing: A small plate and screws are usually placed on the front of the spine.
7. Closing: The incision is closed with dissolvable stitches and skin glue.

This animation shows how an ACDF is performed:

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Anterior Cervical Discectomy and Fusion (ACDF), courtesy of Veritas Health

In this video, spine surgeons explain why many neck and back problems are best reached from the front of the spine:

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From the Front to the Back: why anterior spine surgery. Video courtesy of Centinel Spine.

Benefits and Risks

Benefits

• Relief of arm pain for most patients, often soon after surgery
• Removes pressure from the spinal cord and helps prevent further damage
• Restores disc height and opens the nerve passages
• A long track record of reliable results

Risks

• Sore throat, trouble swallowing or hoarseness, which usually improve over several weeks
• Infection or bleeding
• The bones not fusing (nonunion), which is more common in people who smoke
• Extra wear at the levels above or below the fusion over time (adjacent segment disease)
• Nerve or spinal cord injury, which is rare
• Risks related to anesthesia

Why Choose Dr. Betsy Grunch for Your ACDF

• Duke-trained: Dr. Grunch completed her neurosurgical residency and a spine research fellowship at Duke University School of Medicine, one of the top neurosurgery programs in the country, where she received the Spine Young Investigator Award.
• Motion-preservation expertise: Cervical and lumbar artificial disc replacement are among her signature procedures, so fusion isn’t your only option.
• Experience you can count on: She has been in practice since 2013 and performs 400 to 600 surgeries a year, more than 5,000 procedures over her career.
• Every option for your neck: She performs ACDF, cervical disc replacement, foraminotomy, laminoplasty and posterior fusion, so your recommendation is based on what’s best for you.
• Second opinions and revisions: She regularly sees patients who had spine surgery elsewhere and want a second opinion or need a revision.
• A teacher at heart: As “Ladyspinedoc,” she is known for explaining spine conditions clearly. You’ll leave your visit understanding your imaging and every option in front of you.

What to Expect

Before surgery

You’ll meet with Dr. Grunch or one of her physician assistants to review your imaging, your exam and your goals, and to decide together whether an ACDF is right for you. Our team will coordinate any pre-operative testing, review your medications (including blood thinners you may need to pause) and walk you through the day of surgery so nothing is a surprise. If you smoke or use nicotine, stopping before surgery lowers the risk of complications.

Procedure day

An ACDF usually takes one to two hours per level. Many patients go home the same day, and some stay one night in the hospital, especially after a multi-level surgery. You’ll be up and walking the day of surgery.

Recovery timeline

• First two weeks: Arm pain often improves quickly. A sore throat, trouble swallowing and pain between the shoulder blades are common and improve over several weeks. You may wear a cervical collar until your follow-up visit.
• Three to six weeks: Many patients return to work, depending on the job. Pain medication and a muscle relaxer are usually needed for four to six weeks.
• Four to six weeks: Your follow-up visit, with X-rays to check healing.
• Three to twelve months: The bones continue to fuse. Most patients are back to normal activities, and numbness and strength can keep improving.

Every patient heals differently. Your exact timeline will depend on your symptoms, your job and your overall health.

Watch Dr. Grunch’s post-op care instructions:

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Video: Post-op Care for Anterior Cervical Discectomy and Fusion, from Dr. Grunch on her Ladyspinedoc channel (YouTube)

Caring for yourself at home

• Swallowing and diet: A sore throat and some pain with swallowing are normal and improve over several weeks. Eat soft foods for the first week, such as soups, oatmeal and mashed potatoes, and avoid breads and tough meats until swallowing is comfortable.
• Expected aches: Pain between the shoulder blades is common and improves over several weeks.
• Walking: Walk 30 to 60 minutes a day, broken into 10- to 15-minute sessions.
• Restrictions for about six weeks: No lifting more than 10 pounds and no working above shoulder level. That includes vacuuming, laundry, golf, yard work and lifting young children or grandchildren.
• Your incision: You may shower, gently cleansing and patting dry without scrubbing. Don’t use ointments or creams, and don’t submerge your neck in a bath, hot tub or pool for six weeks.
• Medications: Avoid anti-inflammatory medications such as ibuprofen, naproxen, meloxicam and celecoxib, which can interfere with fusion. Pain medication and a muscle relaxer are usually needed for four to six weeks. Take pain medication with food and avoid alcohol while taking it. A daily stool softener helps prevent constipation. Blood thinners are held for 5 to 7 days after surgery until Dr. Grunch’s team tells you to restart them.
• Driving: You may drive once you are no longer taking narcotic pain medication.
• Follow-up: Your follow-up visit is about four to six weeks after surgery.

Learn how a bone growth stimulator can support your fusion:

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Video: Spinal Fusion Patients: Are You Using a Bone Growth Stimulator?, from Dr. Grunch on her Ladyspinedoc channel (YouTube)

If you go home in a cervical collar, watch how to wear it correctly:

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Video: How to Correctly Wear the Aspen Vista Cervical Collar, from Dr. Grunch on her Ladyspinedoc channel (YouTube)

Call the office at 470-293-9800 if you have a fever over 101°F, redness, warmth or significant drainage from the incision, increased swelling that makes swallowing difficult, trouble swallowing food or liquids, calf pain or swelling, new trouble controlling your bladder or bowels, or worsening neck or arm pain. Go to the emergency room or call 911 for neck swelling with trouble breathing, chest pain or shortness of breath.

Collar and bone stimulator: You may be asked to wear a cervical collar until your follow-up visit. Some patients are also prescribed a bone growth stimulator to help the fusion heal.

Download your patient instructions

Print these sheets or save them to your phone so you have them before and after surgery:

• About your surgery: Anterior Cervical Discectomy and Fusion (PDF)
• Post-operative guidelines: Anterior Cervical Fusion (PDF)

You’ll find instructions for other procedures on our Patient Resources page.

Frequently Asked Questions

Will I be able to move my neck after a fusion?

Yes. Fusing one or two levels has only a small effect on overall neck motion, and most people don’t notice a difference in daily life.

Why does it hurt to swallow after surgery?

The esophagus is gently moved aside during surgery, which can cause temporary swelling and soreness. Soft foods help, and it usually improves over several weeks.

Why can’t I take ibuprofen after surgery?

Anti-inflammatory medications can slow bone healing and interfere with fusion. Dr. Grunch’s team will tell you when it’s safe to restart them.

Should I have an ACDF or a disc replacement?

Both relieve pressure on the nerves and spinal cord. A disc replacement preserves motion but is only right for certain patients, depending on your facet joints, bone quality and the number of levels. Dr. Grunch will review your imaging and explain which is best for you.

Will the plate and screws set off metal detectors?

They are small and usually don’t set off airport metal detectors, and they are generally safe for MRI. Let any future doctor know you have them.

Take the First Step Toward Relief

A pinched nerve or a compressed spinal cord in the neck shouldn’t be ignored. Whether you need a treatment plan, a second opinion or a clear explanation of your imaging, Dr. Grunch and the Southern Neurosurgery team are here to help.

Call 470-293-9800 to schedule an appointment or contact us online.

Have a question first? Ask our virtual assistant anything, 24/7.

We see patients across metro Atlanta and North Georgia at our offices in Gainesville, Sandy Springs and South Atlanta (Riverdale). Find the office nearest you.

Related pages: Cervical radiculopathy · Cervical myelopathy · Cervical discectomy · Cervical disc replacement · Posterior cervical fusion

This page is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. Please talk with your own doctor about your symptoms. If you have sudden weakness, trouble walking, or new bladder or bowel problems, call 911 or go to the nearest emergency room.