Anterior Cervical Discectomy & Fusion Instructions

An Anterior Cervical Discectomy and Fusion, otherwise known as an ACDF, is a neurosurgical procedure that is undertaken to alleviate and treat damaged cervical discs of the spine.

There will be a small incision made in the front of the neck (anterior means front, posterior means back) in order to access the damaged discs in question. It is at this time that the pressure on the nerve roots and spinal cord will be relieved by removing the damaged disc or discs. When the disc is successfully removed, a spacer will inhabit the region where the damaged disc previously was in. This spacer can be made out of a diverse set of materials, such as the patient’s own bone material, donor bone or PEEK. This spacer will then join/fuse the vertebrae of the cervical spine together. In order to ensure that the spacer is securely in place, the graft (spacer) is held in place by using a small metal plate and screws.

As the body and spine heals over time with adequate rest and restrictions, the vertebrae will grow together into what is known as a fusion. Fusion can take from months to years to heal, with a myriad of variables contributing to healing and recovery time. For example, tobacco use can drastically affect healing time making it longer for vertebrae to fuse.

If there are any question or concerns you wish to address about the procedure, please contact our medical staff at Princeton Brain, Spine and Sports Medicine.

• A week before your surgery is scheduled, do NOT take any NSAIDs (non-steroid anti-inflammatories, e.g. Aleve, Advil, Ibuprofen, Naprosyn.. if you are unsure if your medication is appropriate to take before surgery, please contact our medical staff at Princeton Brain, Spine and Sports Medicine before doing so)
• Do not eat or drink any food or beverage after the midnight before your surgery. The only exception is to take your normal medications with a sip of water.
• If you are diabetic and require insulin, please consult your Princeton Brain, Spine and Sports Medicine neurosurgical provider about taking this before surgery.
• Please prepare to arrive an hour before your scheduled surgery, as if you are late for arrival the surgery may have to be cancelled.
• If you have a pre-operative folder and relevant imaging (MRI, CT, X-Ray), please bring them with you to surgery.
• As stated above, tobacco use is detrimental on recovery and healing time. It is to be understood that if you partake in tobacco usage, you must abstain two weeks before surgery and two weeks after surgery. Lengthening the halt of tobacco use or quitting all together will not only aid in your recovery for surgery, but will aid in your general health and well-being overall.

I have a weird feeling in my throat when I swallow/sore throat/significant phlegm production. What’s going on?

With having an anterior procedure, these side effects are often experienced by others such as yourself. Difficulty with swallowing (dysphagia), sore throat causing a loss of voice, etc is nothing unusual.  These side effects are most prominent two to five days after surgery and will then begin to subside. Sleeping with your head elevated for the first few days after surgery may aid with these symptoms. If you have any problems with breathing, please seek medical attention immediately.

My incision site/wound site hurts. What’s going on?

Pain varies from person to person in regards to their incision. There usually is mild pain at the incision area, though it is more common to experience pain at the base of the neck and your shoulder blades due to the disc space distraction. If there is excessive swelling, drainage, or pus from the incision site please get medical attention immediately. If there is fevers, chills, or nausea please receive medical attention immediately.

How should I dress my wound? How long until I can dress and bathe normally again?

Your bandage may be removed the second day after surgery. The steri-strips, staples, and sutures should be left on the incision until you come to your post operative visit so we may exam the wound and remove them for you. This is between one and two weeks after surgery.

You may shower the fifth day after surgery if there is no drainage from the incision. If there is drainage, call the office. Excessive showering may irritate the incision. Please also do not make direct contact with the incision, rather let the water naturally run over it. Do not enter a hot tub, bath tub, pool, ocean or any other body of water until at least three weeks after surgery. Entering any non-sterile body of water may cause infection of the incision site.

When can I go about my activities of daily living as normal again? Do I have restrictions?

• Do not lift more than five to ten pounds for the first three weeks after surgery. This can slowly be increased to twenty pounds at around four to six weeks post surgery. Do not lift anything over twenty pounds until after three month post surgery,
• You can drive two weeks after surgery as long as you are not experiencing discomfort when doing nor are taking pain medications. Please note that taking pain medications and driving is illegal as pain medications can alter your neurological state of wakefulness and consciousness, making it dangerous to drive.
• Please avoid sitting upright on a hard surface or long care rides until two to four weeks after surgery.
• Please limit your bending and twisting of your neck (cervical spine). If you are to undergo physical therapy, you are to abstain from range of motion, flexion, extension or lateral bending until the fusion of your vertebrae are documented.
• Please avoid any activity that presents the potential of falling or any physical contact (ex: sports, playing with children) until given permission by your neurosurgical provider.
• Please begin exercising in a safe manner by walking as soon as able after surgery. Walking is a great way to prevent blood clots, to increase muscle strength, and to better your cardiovascular health.

Diet: Pain medications can cause constipation. Using stool softeners and laxatives as well as engaging in a high fiber diet will aid with this. Straining yourself on the toilet is to be avoided, please aim to keep your stool malleable with the recommendations above.

Pain Medication: Do not take NSAID medications or Cox-2 inhibitors for three to six months after surgery, though Tylenol can be taken for pain as needed. If Tylenol is not providing you relief, please contact your neurosurgical provider to discuss narcotic pain medication. Do not allow your pain to become unmanageable before contacting your doctor, as it will be more difficult to treat.

Hospital stay: As ACDF surgeries can be performed on more than one level, the hospital stay needed may vary. A single, two or three level surgery and you may be able to return home the day of surgery. You may have to go home the day after surgery for anything more extensive.

Returning to work: You can return to work depending on how you feel you are progressing after surgery. Usually, two weeks to recover is sufficient though you may be able to discuss when you feel able to return to work and a medical recommendation with your neurosurgical provider. If you are employed at an occupation that requires excessive physical exertion or labor, you may not be able to return to work for up to one month. This can vary and should be discussed with your neurosurgical provider.

Physical Therapy: Physical therapy is normally referred at your first post surgical visit. As stated above, please avoid twisting and bending your neck with physical therapy. If you begin to feel pain with physical therapy, stop and abstain from doing that specific motion and discuss with your neurosurgical provider the issue at your next post operative visit.