PATIENT GUIDE TO MINIMALLY INVASIVE ANTERIOR CERVICAL MICROSCOPIC
neck operation called an anterior cervical discectomies and
fusions (ACDF) is a very common surgical procedure. It is
generally safe, effective, and expected to return you to normal
activity within a few weeks after surgery. It is an approximately
one hour procedure, done as an outpatient or as an overnight stay
in the hospital. Below is a guide to the procedure that I hope you
will find helpful.
FOR SURGERY: You will be asked to shower using a special
soap, the night before or the morning of the surgery. It will be
given to you by the hospital at your pre-operative evaluation. You
should not eat or drink anything after midnight before surgery.
You will be instructed if you need to stop any medications prior
to your surgery by our office staff.
THE PROCEDURE: Once you enter the Operating Room, you
will be given an intravenous medication. This will put you deeply
asleep, and you will remember nothing of what occurs afterwards.
The procedure takes approximately an hour, after which I will contact
your friends or family. From the time you are wheeled back to surgery
to the time I come out to speak with your friends or family is about
The procedure starts with a small incision to the right of your
Adam's apple. The incision is almost always on the right side,
regardless of which arm or which side of the neck hurts. I attempt
to put the incision in a skin crease, so that 6-12 months after
surgery it is often not visible. Your disc has been disrupted, and
it is standard practice to remove it entirely. The operating microscope
is used to perform all dissection near the nerves because that allows
the operation to be done very safely, in a minimally invasive manner.
next portion of the procedure is called the fusion. The discs in
the body are named for the bones they are between. For example,
there are seven bones in the neck, and if your disc rupture is between
the number six and number seven bones, it is called the "C67
disc". The goal of the fusion is to make the C6 and C7 bones
into one bone. This is done by taking a piece of bone from our tissue
bank and sliding it between the two after the disk has been removed.
Over many months, the bones will heal together as one. Many people
worry that taking a piece of bone from someone else presents the
risk of getting either hepatitis or AIDS. Although this is theoretically
possible, I have not heard of a single such case in over 30 years
of practice, and the chance of contracting such an illness is less
than one in tens of thousands. Your body's own bone cells will soon
begin to replace this bone from the tissue bank. Many people also
worry that the fusion will decrease your ability to move their neck.
There will be no change in your neck motion that you
fusion, I usually place a plate over the disc and two bones. The
plate is made out of either plastic or metal. It is extremely small,
and is about the size of half a postage stamp. Plastic or metal
screws will go into the bone above and below, to keep it in position.
These plates have become extremely popular in recent years for a
number of reasons. The main one is that they eliminate the need
to wear a collar after the surgery. In addition, they allow a very
rapid return to work. This is usually within a few weeks regardless
of your profession.
incision is closed. We no longer use stitches in the skin. Instead,
a surgical glue is used, which will dissolve over a couple of weeks.
For weeks to months afterward, the incision will appear as a very
thin and perhaps purple line. In some people, it is more prominent
than others. In general, between six months and a year after the
surgery, it will be difficult to see the incision at all.
This is one of the most satisfying and reliable operations that
I perform. Many people have severe arm pain before the procedure,
and the expectation is that this will be gone immediately after
the surgery in the Recovery Room. Not everyone improves that quickly,
but most people do. The strength will generally return quickly in
a matter of a few weeks. Numbness is the least predictable in regard
to recovery, and you may have some numbness in the hand or forearm
An ACDF is a very safe procedure. In the medical literature, the
risk of a serious complication such as a spinal cord injury is under
one half of 1%. I have performed over 1,000 of these procedures
for over four decades. The risk of an infection is also under 1%.
The chance of the bone not fusing is in the range of 4%. The risk
of hoarseness is very rare. There are some specialists that believe
that a fusion causes increased stress at the spinal levels above
and below. This might lead to another herniated disk, or excessive
bone spur formation. I have not found this to be a problem in my
THE SURGERY: You are always free to contact me in the office
or through my answering service. In general, you will be seen about
2 weeks after the surgery, to check the incision and to make sure
that all is healing well.
Stephen Saris M.D.