A Patients' Guide to Outpatient Surgery

Anterior Cervical Discectomy and Fusion (ACDF) at an Outpatient Spine Center

Minimally invasive spine surgery treats different painful neck conditions

There are many things to consider if your surgeon recommends neck surgery to treat a spinal disorder, such as a cervical herniated disc. You may question how long you may need to be hospitalized and what to anticipate about the recovery process. These are valid concerns. It may help alleviate some of your concerns to know that surgical treatment of certain neck disorders can be treated using minimally invasive spine (MIS) techniques in an outpatient surgery setting. Anterior cervical discectomy and fusion, or ACDF is one such MIS procedure.

If you need anterior cervical discectomy and fusion, you may be a candidate to have the procedure performed in an outpatient facility and return home the same day. While many types of minimally invasive spine surgeries (MISS) can be performed in an outpatient setting, this article focuses on minimally invasive ACDF.

nerves in the neck, cervical spine, compressed by different disordersSpine Surgery in a New Setting: Minimally Invasive Anterior Cervical Discectomy and Fusion
The minimally invasive approach to neck surgery uses a small incision compared to traditional open neck surgery. Often, the incision is made in a natural skin fold at the front of the neck, which—when healed, is virtually invisible in most patients. Furthermore, MISS utilizes smaller instruments, which means the size of the surgical field (called exposure) is reduced. Overall, this lessens the amount of healing you have to do.

Similar to other minimally invasive spine procedures, ACDF utilizes specially designed surgical instruments that allow the surgeon to avoid disrupting (eg, cutting) soft tissues in the cervical spine, resulting in less pain. MISS procedures are typically safer, quicker, and promote a faster recovery than traditional spine surgery.

The hallmark benefits of minimally invasive spine surgery include:

  • Smaller incision(s)
  • Less blood loss
  • Lower risk of muscle and soft-tissue  damage
  • Lower risk of infection
  • Reduced postoperative pain
  • Reduced pain medication use
  • Faster recovery

While MISS often focuses on the size of the incision, it’s really a larger concept of being minimally traumatic to the body—in this case, it’s the neck structures that matters. The advances in MISS techniques have given spine surgeons a new way to perform ACDF, and enable the surgery to be performed in an outpatient setting. After a postoperative period of recovery in the outpatient surgical center, patients are discharged home the same day of their surgery.

Conditions Treated with Minimally Invasive ACDF
Anterior cervical discectomy and fusion may be recommended to treat many neck problems, including:

  • Cervical radiculopathy
  • Degenerative disc disease in the neck
  • Herniated disc in the neck
  • Cervical spinal stenosis
  • Cervical spinal fracture

What Happens During an Outpatient Minimally Invasive ACDF?
The goal of a single-level anterior cervical discectomy and fusion is two-fold:

  1. Reduce pain by decompressing the nerve roots and spinal cord
  2. Stabilize the neck

The surgeon accomplishes both goals by first performing a discectomy to remove the intervertebral disc and other tissues (eg, bone spurs) compressing nearby nerves and/or the spinal cord. Removing the tissues pinching or pressing on a nerve is called decompression. The cervical level (eg, C3-C4) operated on is then stabilized by implanting spinal instrumentation that is affixed to the adjacent vertebral bodies (implanted and/or affixed to the neck).

surgeons in the operating roomHow ACDF is Performed Minimally Invasively
Prior to surgery, you are positioned on the operating table face-up, and general anesthesia is administered. As the name of this procedure denotes, ACDF is performed from the front of your neck.

The surgeon makes a small incision no longer than 2-inches near the front of your neck, usually in a natural skin fold to help disguise the scar when healed. A tubular retractor is inserted through the skin incision to separate and hold neck muscles and soft tissues apart during the procedure. The surgeon wears special magnifying eyeglasses or uses a surgical microscope to enable a microscopic view of the surgical field. Through the tubular retractor, the surgeon performs a discectomy (disc removal), and removes—as necessary, bone spurs (ie, osteophytes) that may be compressing nearby nerves and/or the spinal cord.

After the discectomy, the empty disc space is prepared for implants called spacers. Spacers separate and maintain “space” between the upper and lower vertebral bodies necessary to avoid nerve compression. Spacers are available in different sizes, so the surgeon first uses trial spacers to determine the best implant size. Spacers are made from different materials, including PEEK (polyether ether ketone), titanium, or machined allograft. The selected size of spacer is implanted into the empty disc space with bone graft packed in it.

A cervical plate may be affixed using screws to stabilize the spine. Alternatively, some surgeons, including myself, prefer using a stand-alone implant, which incorporates space for the bone graft and the fixation screws/mechanism, rather than an anterior plate. The advantage of the stand-alone implant is it limits the length of the incision above and below the disc space, because there is no need to create space for a plate. This further supports the goal of limiting the size of the incision. The implant is then placed into the empty disc space, and the screws are inserted into the adjacent vertebral bodies to secure the device.

From start to finish, an ACDF procedure in an outpatient spine center takes approximately 30 to 45 minutes.

Minimally Invasive Anterior Cervical Discectomy and Fusion Considerations
Minimally invasive ACDF offers patient many potential benefits compared to traditional open neck decompression and stabilization surgery: a smaller incision and faster recovery time. However, not everyone is a candidate for this procedure in an outpatient setting.

Some cervical conditions are best treated with a traditional open approach, so your particular diagnosis will be taken into account when weighing whether MISS is right for you. Also, patients with other serious health problems, such as a heart condition, may be suited for a minimally invasive ACDF procedure, but the surgery should be performed in a hospital in case unexpected treatment for their co-existing medical condition is warranted.

Other complications that may arise as a result of a minimally invasive ACDF include:

  • Nonunion of the spinal fusion (when bones don’t fuse as planned)
  • Hoarseness of voice or other voice changes
  • Broken or loose instrumentation/implants
  • Throat soreness

Your surgeon will review all potential risks related to minimally invasive ACDF with you prior to surgery.

Conclusion
The minimally invasive approach is a favored surgical option for patients who are candidates for anterior cervical discectomy and fusion at an outpatient spine surgery center. ACDF may reduce your neck pain and related symptoms by relieving compression on nerves in your neck and stabilizing the cervical spine. After your surgery, you can expect a small incision and minimal soft tissue disruption that can speed up your recovery time compared to traditional open neck surgery.

Updated on: 02/28/17
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