Anterior Cervical Fusion Surgery
Cervical Spondylosis is a very common degenerative spine disorder. Mostly elderly people are affected; however, it can affect younger patients also. Anterior Cervical Fusion is gold standard procedure for these patients. Cervical spine is approached from the front. Anterior cervical fusion can be divided in 1) Anterior Cervical Discectomy and Fusion (ACDF), and 2) Anterior Cervical Corpectomy and Fusion (ACCF).
Anterior Cervical Discectomy and Fusion (ACDF): ACDF involves removal of cervical disc/ discs and reconstructing the space with a bone graft/ cage/ anterior cervical plate or a combination of these. This is procedure of choice when disc and osteophytes are bulging in spinal canal and causing pressure on spinal cord. A multilevel ACDF can be done depending upon the number of discs affected.
Anterior Cervical Corpectomy and Fusion (ACCF): ACCF involves removal of cervical vertebra/ vertebrae, either partially or completely. An ACCF is required when spinal cord is compressed behind the vertebral body, which cannot be approached by cervical discectomy. Some surgeon’s prefer doing an ACCF rather than multilevel ACDF to tackle multilevel cervical spinal cord compression.
Indications:
- Cervical Spondylosis: Causing severe neck pain, not responding to medical treatment.
- Cervical Radiculopathy: Compression of cervical spinal nerve causing pain, tingling-numbness, sensory changes, muscle weakness in upper limbs.
- Cervical Myelopathy: Patients who have feature of myelopathy (hand grip weakness, clumsiness of hand functions, loss of body balance, difficulty in walking, stiffness in arms and legs, loss of bladder-bowel control).
- Cervical Spine Fractures.
- Cervical Spine Infection/ Tuberculosis.
- Cervical Spine Tumors.
Advantages of Anterior Cervical Spine Fusion Surgery:
- A minimally invasive procedure.
- Very well tolerated by patients.
- Targets the pathology (disc, osteophytes etc.) directly.
- Very safe and effective procedure.
- Very unlikely to cause any major side effects.
Side effects of Anterior Cervical Spine Fusion Surgery:
ACDF and ACCF are both very safe surgeries. However, like any other surgery, common complications, e.g. pain, infection, hematoma etc. can happen. Even these are extremely rare with anterior cervical fusion surgeries as significant soft tissue and muscle dissection are not required when cervical spine is approached from the front. Some difficulty in swallowing can be experienced by the patients due to close proximity to oesophagus (food pine passing through the neck to stomach). This happens in the immediate post-operative period and usually resolves within 3-4 days. Hoarseness of voice is another rare complication which can occur due to irritation of nerve supplying vocal cords (voice box situated in neck). Again, this is usually a self-resolving condition.
Recent Advances:
- Stand Alone Cage: Conventionally, ACDF is done using a cage in interbody area from where disc is removed, which is supported by a plate applied on anterior surface of cervical spine. Plate can irritate oesophagus and other soft tissues in neck causing pain of swallowing in some cases. This is avoided by using a stand-alone cage as it is fixed by screws passing through the cage itself.
- Minimally Invasive Anterior Cervical Spine Fusion Surgeries: ACDF and ACCF can be done following minimally invasive spine surgery principles using specialized retractors and microscope.
- Disc Replacement Surgery: Cervical disc replacement is an alternative to ACDF, especially in young age patients. This will maintain motion at operated level and will reduce chances of adjacent segment degeneration(ASD).