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ACDF is a spine surgery in the neck area, approached from the front, so as to relieve pressure being put on the spinal cord and the spinal nerve roots(spinal decompression procedure) by the bulging or herniated disc. Intervertebral disc is removed(discectomy), replaced with implant,metal and/ or bony graft and affected vertebrae are joined together(fusion) with the help of a metal plate and screws to provide stability and strength to the spine and allow them to heal as a single entity.Symptoms such as neck pain and pain,tingling,numbness in the arms and hands are taken care of. This surgery may be done at a single or multiple levels.
Q1. What is the structure of a healthy spine or back bone?
A1. Spine or the vertebral coloumn comprises of a series of interconnected small bones called vertebrae extended from the base of the skull to the tail bone or coccyx, secured together with the help of ligaments and back muscles. Spine is designed to safeguard the spinal cord that serves the function of transmitting neural signals from the brain to the rest of the body. Each vertebra in the spine is kept apart from each other by intervertebral discs.
An intervertebral disc is structured just the way as the doughnut, with soft jelly like substance called Nucleus Pulposus in the centre enclosed by ring shaped tough outer covering called Annulus Fibrosus. Disc serves three main functions as the following:
In a healthy intervertebral disc, jelly like centre(Nucleus Pulposus) holds water with the help of small molecules. These sponge like molecules can attract and hold 500 times their own mass in water. Ring like structure enclosing the Nucleus Pulposus is called the Annulus Fibrosus.It is a tough, thick fibrous structure made up of collagen. It keeps the nucleus well in the centre of the disc.In a healthy disc Annulus is very flexible. Annulus has its own nerve supply. Nerve roots branch out from the spinal cord.
The stacked up vertebrae come into contact with each other only at the facet joints, that lie just behind the spinal nerve roots and permit them to move relative to one another. The disc depends upon the transfer of the nutrients and the fluids between the upper and lower vertebrae and the anuulus Fibrosus to remain healthy.
Q2. What damages the intervertebral discs?
A2.Excessive weight on the disc, pressurizes the disc thereby slowing down the transfer of the important nutrients and fluid in the disc from the upper and lower vertebra and the outer layer of the Annulus fibrosus that normally happens in a healthy state. Persistent wear and tear leads to disc dehydration and degeneration.Furthermore, excessive weight, improper posture, repetitive movements and heavy lifting can speed up the damage process. Disc degeneration is characterized by loss of fluid in the nucleus pulposus causing it to shrink and resulting in the decreased space between the vertebrae. It leads to more friction between vertebrae at their point of contact i.e., facet joint resulting in pain and irritation called Facet Syndrome.
Besides the above, disc dehydration also causes the tough but flexible outer ring like structure(Annulus Fibrosus) to become fragile and vulnerable to cracks and tears that may result in Disc herniation. Since the Annulus Fibrosus has its own nerve supply, small cracks and tears in it may result in severe pain in the affected spine area.With the worsening of the tears, the jelly like material may push through the tough Annulus fibrosus boundry causing the disc to bulge.
Progressive deterioration of the above condition puts pressure on the nerve root. A compressed nerve gets irritated and inflamed causing symptoms such as pain,tingling,numbness etc in the affected part or the areas of the distribution of that nerve root.
Q3 What is spinal decompression?
A3 Spinal decompression is carried out to relieve the pressure that is being put on the spinal nerve roots and the spinal cord due to the bulging or herniated intervertebral disc.
Q4 What is spinal fusion?
A4 Spinal fusion is a surgical procedure in which two or more vertebrae are joined together to make them a single entity by using bone graft material and the hardware(plate and screws) used in surgery. It is carried out to get rid of the movement of the affected vertebra leading to the stability of the spine and reducing pain associated with it.
Q5 Which conditions call for spinal fusion surgery?
A5 Spinal fusion is recommended under one of the following conditions:
Q6 What is done in Anterior cervical discectomy and fusion(ACDF) surgery of the spine?
A6.ACDF is done under general anesthesia with the patient positioned on his/her back. During this procedure an incision is made in the front of the neck to reach the affected vertebra directly(anterior approach) as it is easier to access the intervertebral disc from the front. Muscles are moved sideways. Once reached,the affected intervertebral disc is taken out(discectomy), bony edges of the vertebra are refined(osteophytes or the bone spurs are removed as well and irregular bony edges are made smooth to make adequate vertebral space for the implant and remove pressure from the spinal cord and the spinal nerve roots). Affected vertebra is positioned back to its original normal position if discs got collapsed as a result of disease.
Intervertebral discs are replaced with implants that may be either made from synthetic material or bony graft(from the patient's hip bone-Autograft)or harvested prior to the surgery from the donor(Allograft). The implant supports the affected vertebra and keeps them in lace while they heal. Then the affected vertebrae are jointed together with the help of the surgical hardware(plate and screws) so that they can heal together as a single entity.This hardware provides extra support to the vertebrae and strengthen the new arrangement.
Incision is now closed.
Surgery may be done at a single or multiple levels as per patient's requirement.
Dr Puneet Girdhar
Director Orthopedics Spine Surgery
BLK Orthopedics centre for Orthopedics, Joint reconstruction and Spine Surgery
BLK Super Specialty Hospital, New Delhi.
Dr P.K Sachdeva
Director & Head, Neurosurgery
Saket, New Delhi
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Mr Kwasi (Ghana)
08 Jan , 2017
I had been suffering from excruciating low back ache since last few years. Several sessions of physiotherapy, pain medications and frequent visits to the consultant all went futile. I was no longer able to carry out the normal daily activities. I was advised to undergo spine surgery by my doctor. I am glad I found HealthcaretripIndia. They got me comprehensive medical opionion from best spine