As our society gets older as a whole, more and more people need ACDF and PCDF surgeries. Last September, I had my own combination ACDF/PCDF surgery (anterior cervical discectomy with fusion, followed by a posterior cervical discectomy with fusion). What are these surgeries? Why do you have them? How do they help? What are the risks? How does the recovery go?
Neck Surgery Vocabulary
First, some basic definitions:
Anterior = front side of your body
Posterior = back side of your body
Cervical = neck
Discectomy = removal of a damaged disc
Fusion = insertion of bone plugs and/or pieces of metal (plates, rods, cages, etc.) into/around spinal bones to encourage bone growth
In a nutshell, an ACDF is a surgery in which a neurosurgeon or orthopedic surgeon opens the front side of your neck to remove damaged discs and correct problems in the alignment of your cervical vertebrae (neck bones). The doctor may use bone plugs and/or hardware to support your spine while it heals into the new alignment. "Spinal fusion" occurs when your body grows bone around/over the hardware and/or bone plugs. (It works in the same way that a broken bone knits itself back together.)
A PCDF is something similar... the surgeon opens the back side of your neck to remove damaged discs and repair cervical alignment and insert bone plugs and/or hardware (most often, rods/screws) to support the spine until "spinal fusion" occurs.
ACDFs and PCDFs are two versions of so-called "spinal fusion" surgeries. You can have an ACDF or PCDF individually, or can have both done in sequence. In September, I was scheduled for an ACDF surgery on a Tuesday and a PCDF the following Friday, with a hospital stay in between. (It didn't work out that way, but that's another story for another day.)
In some ACDF/PCDF operations, the surgeon may use something snazzy called "bone morphogenic protein". (I call it "bone glue".) This special stuff encourages bone growth, increasing the chances for a solid spinal fusion to occur. Read more: Spinal Fusion Surgery and Bone Morphogenic Protein, from Cornell University's Weill Medical College website.
Spinal Fusion Surgery: What is It? How is It Done?, from the North American Spine Society.
Surgical: Anterior Cervical Discectomy with Fusion, from necksurgery.com. Includes some basic illustrations of the surgical procedure.
Anterior Cervical Discectomy, from SpineUniverse.com
A Patient's Guide to Posterior Cervical Fusion, from the Maryland Spine Center at the University of Maryland Medical Center.
Posterior Cervical Fusion, from the University of Southern California Center for Spinal Surgery.
A Patient's Guide to Cervical Kyphosis, from the University of Maryland Spine Program
Why Would You Need an ACDF or PCDF?
ACDF and PCDF operations are recommended to correct physical misalignment of the cervical spine, which can be due to scoliosis, spondylolisthesis, kyphosis, fractures, and other causes. ACDF and PCDF operations are also sometimes pursued to alleviate pain caused by ruptured discs and/or narrowing of the spinal canal (stenosis). Ruptured discs and stenosis can compress spinal nerves or the spinal cord itself, causing pain. Spinal fusion is a somewhat controversial treatment, as USA Today reports, because it is most effective at alleviating pain caused by nerve or spinal cord compression and less effective at alleviating pain caused by general disc degeneration.
Patients with conditions like arthritis, Marfan Syndrome, cerebral palsy, and muscular dystrophy are more likely to need ACDF/PCDF surgeries. Spinal cancer can also lead a surgeon to recommend an ACDF or PCDF.
What Are The Risks?
ACDF. The largest risks relate to loss of your voice and your ability to swallow. Both can be temporary or permanent. Some patients require feeding tubes after surgery. Others will require a diet of thin liquids for several weeks or months. At a minimum, most patients will need to cut food into very small bites for a few days or weeks after the surgery. Voice loss can be permanent if the surgery damages the recurrent laryngeal nerve. It can also be temporary, caused by post-op swelling.
PCDF. The largest risks relate to the sheer pain of the procedure and the possibility of damage to the spinal cord itself (which can cause death). Many muscles in your shoulders and neck help hold up your head. Cutting through muscles like these creates a LOT of pain. (Doctors will tell you this procedure is gonna hurt, and that's how you know you are REALLY in for it).
Spinal fusion surgeries in general. Fusions and hardware used to support them may break down over time. So you may need another surgery a few years or decades after your first. Each subsequent surgery gets more complex (because there is more old stuff to take out) and more risky (because your body is less willing to fuse each time you have a fusion surgery).
For those of you who love details, here is the exact list of risks associated with my own ACDF/PCDF surgery (keeping in mind that mine was a massive, extreme fusion from C2 to T1):
Swelling, problems with hoarseness, bleeding, infection, leak of cerebrospinal fluid, meningitis, pain, weakness, paralysis, bowel and bladder problems, failure of fusion, need for further surgery, and risks of anesthesia (heart attack, stroke, death, allergic reaction).
What About Recovery?
It takes most patients's bodies 6 weeks to 3 months to begin fusing (for bone to grow over/around the inserted bone plugs and/or plates, rods, screws, etc.) Many patients are cleared to return to work at the first evidence of bone healing. Some may require physical therapy first... your doctor will let you know when it is safe to begin PT. Some patients may need to wear a cervical collar (neck brace) for some or all of the first 6 weeks to 3 months. In more complicated cases, the patient may wear the collar for 6 or even 9 months. See my Tips for Wearing A Cervical Collar if you find yourself in this situation!
Recovery (in terms of pain reduction) can vary greatly depending on how long the pain had been going on before the surgery. The longer your body has nerve pain, the harder it is to turn the pain off, even after the reason for pain (your spine problem) is corrected. In addition, nerves may take up to a year to re-set (to realize they are no longer pinched and thus don't need to generate pain).
In the near term (first few days or weeks after the surgery), you may notice an increase in pain or even new pain (pain in your shoulders instead of your arms, etc.). These will lessen and disappear over time. Hang in there!
Your unique medical situation will impact your recovery timeline. If you have chronic health problems, talk to your doctor about how they may affect your healing process.
Coming Home after ACDF/PCDF Surgery
You will need someone's help to do nearly anything the first few days that you are home. (You may be in pain, lightheaded from pain medications, weak from eating bad hospital food, or all of the above.)
Your doctor will likely put you on restricted activity for some period of time (days, weeks, or months). Typically, you will not be allowed to reach above your shoulders, reach down below your waist, lean forward or backward, bend down to pick things up, carry heavy things, push or pull anything, or twist your spine in any way. Your doctor may also ask you to stay at home (no driving or riding in a vehicle) for a while following your surgery (a small fender-bender could undo all the hard work your surgeon put into repairing your neck).