ACDF — Anterior Cervical Discectomy & Fusion

In the neck, a disc can bulge or a bony spur can form and press on a nerve root or the spinal cord. When a nerve root is compressed, it can cause pain, pins and needles or weakness in the arm; when the spinal cord itself is compressed, it can cause a broader loss of function known as myelopathy, affecting the hands, balance and walking. Where these problems are significant, do not settle with non-operative care, or threaten the spinal cord, surgery to relieve the pressure can be considered.

In an ACDF, the spine is reached through a natural plane at the front of the neck, allowing the surgeon to work in front of the spinal cord without disturbing it. The affected disc is removed, along with any bone spurs or disc fragments pressing on the nerve or cord. A spacer — filled with bone graft or a graft substitute — is placed into the cleared disc space to restore its height and hold the nerve exit open, and a small plate and screws are often added for stability. Over the following months the two vertebrae unite into a solid fusion.

ACDF can be considered for cervical radiculopathy that has not settled with non-operative treatment, and for cervical myelopathy where the compression is coming from the front and needs to be relieved. It is particularly suited to one or two levels, and to situations where restoring disc height and alignment is helpful. The alternatives — including cervical disc replacement, a posterior approach, or continued non-operative care — are weighed for each person according to the pattern of compression, the alignment of the neck, and their circumstances.

ACDF is supported by decades of experience and a large body of evidence. Clinical guidelines recognise it as a standard, effective treatment for cervical radiculopathy, and comparative studies show good and durable relief of arm pain and stabilisation or improvement of myelopathy. Research continues to refine details such as graft choice and whether to use a plate, and to compare ACDF with disc replacement for suitable patients. The balanced view is that ACDF is a reliable, well-evidenced operation with a strong track record, while newer options such as arthroplasty offer alternatives in selected cases.

ACDF is usually carried out under general anaesthetic, often with a short hospital stay. Because the approach uses a natural plane, many people recover comfortably, with a sore throat or mild swallowing discomfort in the early days being common. Arm pain frequently eases quickly once the nerve is decompressed, while the fusion consolidates over the following months. Recovery and precautions are individualised. As with any operation there are risks, which are discussed fully beforehand so that decisions can be made together.

• —Bono CM, et al. Evidence-based clinical guideline for diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J 2011. (PMID 21168100)
• —Sattari SA, et al. ACDF versus posterior decompression in degenerative cervical myelopathy: systematic review and meta-analysis. J Neurosurg Spine 2023. (PMID 36840737)
• —Wang T, et al. ACDF versus anterior cervical corpectomy and fusion in multilevel cervical spondylotic myelopathy: systematic review and meta-analysis. Medicine (Baltimore) 2016. (PMID 25673996)
• —Tuchman A, et al. Autograft versus allograft for cervical spinal fusion: a systematic review. Global Spine J 2017. (PMID 28451511)