Relieving the pressure placed on nerve roots and spinal cord

Anterior Cervical Discectomy and Fusion (ACDF)

If you have a herniated disc, Dr. Schwartz may perform an ACDF, which is an operation that involves relieving the pressure placed on nerve roots and/or the spinal cord. Discectomy involves removing all or part of an intervertebral disc. The term discectomy is derived from the Latin words discu (flat, circular object or plate) and – ectomy (removal). Spinal fusion involves placing bone graft between the vertebrae where the disc was to promote a solid column in that area, thereby helping to keep pressure off the nerve roots and spinal canal.

The operation is performed while you lie on your back. A small incision is made to one side of the front of your neck. After moving aside the soft tissue and muscles, your surgeon will then see the disc between the vertebrae. The disc, and in some cases, a portion of bony outgrowth around the nerve roots and/or spinal cord, is then removed to relieve the compressed neural structures and to give them additional space.

Bone graft material is then placed between two vertebrae where the disc used to be. A small titanium plate and screws may also be placed to provide further support while the new graft fills in and heals to a solid fusion over the next few months. The operation is completed when your surgeon places a drain, closes the incision with sutures (stitches) and covers the incision with a bandage.

After Surgery

You will spend one night in the hospital following surgery for observation. To keep swelling to a minimum for the first 24 hours after surgery, the head of your hospital bed will be elevated about 40 degrees. Also, there will be a small drain in your neck next to the incision. It is connected to a receptacle that is clipped to your hospital gown. Your nurse will monitor the amount of drainage overnight, and your physician’s assistant will remove the drain the next day before you go home from the hospital. The area will be covered with a bandage or small dressing. Most people are able to get out of bed and move around their rooms, but need to do this with nursing assistance until they are cleared.

If your surgery involves more than one vertebral level of your cervical spine, you may need to wear a cervical collar for two to six weeks. The collar will be placed on you following surgery. It is to be worn at all times, even while sleeping and may be removed long enough to bathe.

ACDF Discharge Instructions

Nutrition: It is common to experience a sore throat the first few days after this procedure; therefore, have soft foods available at home, such as macaroni and cheese, cottage cheese, yogurt, mashed potatoes, etc. If needed, lozenges may provide relief. Proteins are the building blocks of healing. I encourage drinking a nutritional supplement such as Boost or Ensure three times a day until you are able to tolerate three regular meals per day.

Pain Medications: You will be provided a prescription for oral pain medication to be filled on the way home from the hospital; and you may require pain medication for one to three weeks following surgery. You may be given a prescription for a narcotic that also contains “APAP” or “acetaminophen.” These are generic names for Tylenol. Quantities of Tylenol that exceed 4,000 mg per day will cause damage to your liver. Be sure you do not exceed more than eight tabs per day, and do not take Tylenol along with medications that already contain APAP or acetaminophen. Narcotic pain medications cause the intestines to move more slowly, which allows more time for your body to reabsorb water from your intestines. This can cause your stools to become dryer and hard, thus causing constipation. Therefore, it is recommended to take an over-the-counter stool softener while you are taking narcotic pain medication and to drink plenty of fluids. Over-the-counter products include Colace, Senekot-S, Dulcolax, Miralax or Milk of Magnesia.

After your surgery, do not take non-steroidal medications, such as: Motrin, Aleve, ibuprofen, Excedrin, Relafen, Indocin and Naprosyn for three to six months. These medications inhibit bone fusion healing. I will let you know when it is okay to resume this class of medication.

Wound Care: Keep your incision clean and dry. There will be suture knots at the top and bottom of your incision that may need to be removed at your first post-op appointment. At times, I choose to use “skin glue” called Dermabond that does not require external sutures. If you feel the edges of this clear coating, do not peel or pick. It will come off over time. There may also be strips of tape across your wound called Steri-strips. Please leave these in place, even if they begin to curl up at the edges. They will be removed by me or my assistant at your first post-op appointment. If you find that at the end of the day you can remove your dressing and it shows no drainage on it, then you no longer need to wear a dressing. However, if you have been provided a cervical collar, you may need to keep a dressing taped in place over the incision to protect it from rubbing against the cervical collar. Do not apply any ointments, peroxide or betadine to the incision, as these may inhibit new skin cell growth and delay healing of your incision.

Bathing: No tub bathing or swimming for six weeks. You may shower one day after your surgery. Let the water run over the incision (without the full force of the stream), pat it dry and then let it air dry.

Exercise and Activity: Walking is the most important type of exercise for you. Walk short amounts each day and gradually increase the distance. Take frequent breaks as needed. Your goal should be one mile a day by six weeks. Physical therapy may be prescribed for you later in your recovery, depending on your progress. For the first two weeks following surgery do not lift anything over five pounds or do any repetitive bending or twisting of the neck. Use good body mechanics (always bend with your knees to lift or to pick something up from the floor). No driving until you are off narcotics.

Follow-Up: Your first post-op appointment will be two weeks after surgery; however, if you have concerns prior to this date, we are willing to see you back sooner as needed. The tiny suture knots at each end of your incision will be painlessly removed and X-rays may be taken. Subsequent follow-up appointment intervals will be based on how you are progressing.

Return-to-Work: Status is determined on each individual’s progress, depending on the type of work you do and depending on your baseline of health and activity level prior to the surgery. In general, you may expect to be off work for the first two weeks following your surgery. You should not drive a car or operate heavy machinery while you are still taking narcotic medications.

DO NOT SMOKE! Nicotine constricts your blood vessels and deprives your tissues and bones of the oxygen it needs to heal. Decrease your risk of infection by not smoking.

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