Anterior Cervical Fusion (ACF)

Who needs an ACF?

ACF are indicated for people with a variety of cervical spine conditions, including:

• Herniated disks
• Spinal stenosis
• Spinal instability
• Degenerative Disk Disease
• Bone spurs causing nerve compression

Usually patient undergoing ACF have already tried other treatments, including physical therapy, oral pain medications (anti-inflammatories, muscle relaxers, pain killers), and sometimes epidural steroid injections.

When you visit with your doctor, he or she will help you decide if ACF is an appropriate treatment choice for your neck condition after taking a complete history, performing a thorough physical examination, and reviewing any studies (x-ray, MRI, CT scan, EMG, etc.) you may have had.

How is an ACF performed?

ACF are performed in either a hospital or ambulatory surgery center (ASC).  An anesthesiologist puts the patient to sleep in the operating room.  Intraoperative nerve monitoring and x-ray are also used to help ensure the safest possible environment.  The surgeon and his or her assistants perform the surgery through a small incision on the front of the neck.  Important structures, including the trachea (windpipe), esophagus (foodpipe), and the large blood vessels in the neck are carefully retracted and protected.  Once the cervical spine is visualized the surgeon carefully removes the diseased disc or discs to take the pressure away from the nerves in the spine itself. After the disks have been removed, the surgeon reconstructs the spine to restore its height and promote fusion.

How long does surgery take?

Most ACF take 1-2 hours for the surgeon to perform with minimal blood loss.

How long will I stay in hospital after ACF?

Most patients who undergo ACF at Texas Back Institute spend just 1 night in the hospital, but some can go home on the same day of surgery as an outpatient.  For more extensive ACF procedures, the patient may remain in the hospital for a couple of nights longer.

What kinds of implants are used in ACF?

There are many implants available for the surgeon to use in this procedure.  Surgeons choose the right implant for the right patient to reconstruct the spine and promote fusion:

Cages made of metal or plastic can be used to restore the disc height after the disc has been removed.  Some cages can be used with plates, whereas others were designed to use with plates.

Plates made of metal can be used to stabilize the cervical spine with screws.  Cervical plates are placed on the front of the spine after the cages and bone graft are placed within the disc spaces.

Bone grafts are typically used to promote fusion within each disc space.  Most cervical fusions are performed with either donor bone (allograft) or synthetic bone, but bone graft can also be taken from the patient’s own pelvis during the surgery if that is what the patient prefers.

Regardless of which implants are used, the goals of the surgery remain the same: to give the patient the best possible pain relief and the best possible functional outcome in the safest possible way.

Who performs ACF?

ACF are performed at Texas Back Institute by fellowship-trained, board-certified/board-eligible orthopaedic spine surgeons and neurosurgeons.

How many levels can be included in ACF?

ACF can be performed from 1 to 6 levels, but the vast majority of ACF are performed at 1 or 2 levels.  The most commonly affected levels in the cervical spine which require surgery are C5-6 and C6-7.

Is ACF covered by my insurance?

Most major medical insurance plans, including Blue Cross/Blue Shield, United Healthcare, Aetna, Cigna, and Medicare, cover ACF, but they are still subject to the same deductible and co-payments as other health care procedures.  Surgery may be delayed because many insurance companies require pre-authorization of this surgical procedure, which can take up to 3 weeks.

Will I get better after ACF? 

Anterior cervical fusion is one of the most reliable surgeries that we perform at TBI.  Typically fusion rates are 90-95% for each level fused in healthy, non-smoking patients undergoing ACF for the first time.  Neck and arm pain tend to improve quickly over the first 6 weeks after surgery, especially as the patient goes through post-operative physical therapy.

For most patients our goal after ACF is full unrestricted physical activity, including work, driving, contact sports (football, basketball, skiing), non-contact sports (golf, swimming, tennis, volleyball, running, cycling), dancing, attending social events (sporting events, parties, movies), and taking care of a patient’s family and household (cooking, cleaning, laundry).

Will I have to wear a collar after ACF?

The need for a collar depends on the number of levels fused and the quality of the patient’s bone.  Some patients undergoing 1 or 2 level fusions require minimal immobilization, whereas those undergoing more extensive surgery may need to wear a collar for 2-3 months after surgery.

What are the alternatives to ACF?

The best alternative to ACF is non-operative treatment.  At TBI we take the decision to undergo surgery very seriously.  Our philosophy is that surgery is the last resort in most cases only to be used when all other treatments including time, activity modification, oral medications, physical therapy, and injections have failed.  If we can get you better without surgery, we will certainly try that option first.

Another alternative is disc replacement.  For a small subset of patient who present with neck pain total disc replacement or artificial disc replacement (ADR or TDR) can be an option to consider. TBI surgeons have been pioneers in disc replacement since 2001, and we are pleased to offer this as a treatment alternaticve to ACF in some cases.