Anterior cervical discectomy and fusion (ACDF) surgery has been performed since the 1950’s and was established as a safe and useful mechanism for the treatment of cervical spine disc related pathologies. The most common indications for an ACDF relate to degenerative changes within the cervical intervertebral disc and the subsequent effects on either the traversing spinal cord or exiting spinal nerves. Trauma, infection and tumours of the cervical spine can also be managed with variations of the same technique. The techniques, equipment and materials used have continued to evolve and numerous clinical studies have demonstrated excellent long-term clinical outcomes with ACDF procedures.
Patients are positioned supine on a specific operation table and head support. An incision is made on the right side of the neck at the level marked with pre-operative x-ray guidance. The thin superficial platysma muscle is divided and retracted. Existing tissue planes are dissected, developed and followed down to the pre-vertebral fascia. Important neck structures, such as blood vessels, oesophagus and trachea, are identified and excluded from the surgical field with the assistance of purpose designed retractors.
The correct surgical level is confirmed with the assistance of intra-operative x-ray. The anterior disc capsule is exposed and incised under direct vision. The problematic cervical disc is then cleared using an array of instruments and a high-powered surgical microscope. The posterior disc capsule and posterior longitudinal ligament of the cervical spine is divided and removed in order to relieve any pressure on either the spinal cord, nerve roots or both. It also allows the surgeon to visualise the coverings of the spinal cord and perform further decompression of neural structures more safely. The opposing bone surfaces of the adjacent vertebral bodies are cleared of any residual cartilage in preparation of the intended intervertebral fusion.
A spacer device is inserted into the cleared intervertebral disc space in order to maintain a sufficient intervertebral height and achieve the correct vertebral alignment within the neck. A number of different options are available for this purpose ranging from a piece of the patient’s own bone to a synthetic “cage” implant. The intervertebral spacer can be left unconstrained or secured in position with screws and a small plate.
Once the surgeon is satisfied with the decompression, implant and haemostasis the thin platysma muscle layer is closed over a small-bore wound drain. The skin is closed with resorbable sub-cuticular sutures and covered with an appropriate dressing.
Preparing for Surgery
Ensure that you know what surgical procedure you are having. It is important to understand the reasons for the operation as well as having a realistic expectation of the outcome. If you have any questions regarding your operation please do not hesitate to discuss these with Dr Crispin Thompson.
Ensure that you have received authorisation from your medical aid, including the authorisation number. Different medical aid providers and medical aid plans offer different levels of cover for surgical procedures. It is your responsibility to know what services are covered by your particular medical aid plan, including whether any co-payments are applicable.
Refrain from eating and drinking anything from 02h00 on the morning of your surgery, unless specifically instructed by one of our team members. Patient specific recommendations will be made depending on your specific circumstances.
Present yourself to the Mediclinic Milnerton reception area by 06h30 on the morning of surgery. You will be admitted onto the hospital administrative system by a member of the reception team before being shown to your bed on the ward. You will need to bring your identification document, your medical aid card and number and your authorisation number with you to the reception area.
Bring all your medication with you to the hospital so that the necessary in-hospital prescriptions can be accurately and appropriately formulated. The medication will need to be given to the ward nursing staff when you are admitted to the ward prior to surgery.
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