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Anterior cervical discectomy and fusion: removing a worn or herniated disc through the front of the neck, then joining the two vertebrae. It relieves pressure on a squeezed nerve or spinal cord — and it is not the only way to do that.
The discs in the neck sit between the vertebrae and cushion them. When one bulges, herniates or flattens with wear, it can press on a nerve root or on the spinal cord itself, causing arm pain, numbness or weakness — see cervical radiculopathy and cervical myelopathy.
ACDF reaches that disc from the front of the neck, through a small crease incision, moving the windpipe and gullet gently aside rather than cutting muscle. The disc is removed, along with any bone spurs pressing on the nerve, and the space it leaves is filled with a spacer — bone graft, a synthetic cage, or both. The two vertebrae then heal into one solid piece, sometimes held with a small plate and screws while that happens.
The vertebral bodies and discs are at the front, on the right here, with the spinal cord and the nerve roots leaving behind them. The disc comes out from the front, and the graft goes into the space it leaves.
What the drawing cannot show is how much varies. The graft may be bone or a synthetic cage, and a plate is not always needed — some spacers lock into the bone on their own.
Removing the pressure is the point; the fusion holds the result. The disc cannot be left empty once it is taken out, so the space is filled and the bones join. That is what trades a small amount of movement for a stable, decompressed level.
The same problem can often be treated by replacing the disc with an artificial one instead of fusing. Which suits you depends on the level, the wear around it, and your age.
| ACDF (fusion) | Disc replacement | |
|---|---|---|
| What happens to the level | The two vertebrae join into one | The level keeps moving |
| Suits | Several levels, instability, deformity, worn facet joints, or weak bone | One or two levels, a soft disc herniation, good disc height and healthy joints |
| Neighbouring levels | Take on a little more load over the years | Load is closer to normal |
| Track record | Long, well established for all of the above | Strong for selected patients, in longer follow-up |
| Recovery | Similar for both — most people are home the next day | Similar |
Dr Mathew Tung performs both, and his stated approach is to preserve movement and prefer reversible options over fusion wherever they are suitable. The scan and the examination decide which you are a candidate for.
The scan has to match the symptoms. Disc wear is common on MRI in people with no pain at all. Surgery is offered when the level seen on the scan explains what you are feeling and examination confirms.
An MRI, and sometimes X-rays with the neck bent forward and back. Blood tests and an anaesthetic review. Blood thinners are paused on advice. Stopping smoking matters — nicotine slows bone healing and makes a failed fusion more likely.
Under general anaesthetic, usually one to two hours for a single level. A crease incision at the front of the neck, the disc and any spurs removed under a microscope, a spacer placed, and a plate fitted if needed. The wound is closed with a dissolvable stitch.
Up and walking the same day. A sore throat and some difficulty swallowing are common at first and usually settle within days to weeks. Most people go home the next day.
A soft collar for comfort, if one is advised. Walking daily. No lifting beyond a few kilograms, and no driving until you are off strong painkillers and can turn your head to check blind spots — usually around two weeks.
Desk work in two to four weeks; physical work and sport later, often six to twelve weeks. X-rays confirm the fusion as it solidifies over three to twelve months.
For arm pain caused by a squeezed nerve, ACDF relieves symptoms in the large majority of carefully selected patients. Neck pain itself responds less predictably. Where the spinal cord is compressed, the aim is to stop things getting worse; some function returns, but not always all of it.
ACDF at this clinic is performed by Dr Mathew Tung Yu Yee, a neurosurgeon who has practised since 1984 and specialised in neurosurgery since 1991. He trained in Singapore and the United Kingdom, is a Fellow of the Academy of Medicine, Singapore, and consults in English, Mandarin, Malay and Hokkien.
A single fused level takes away a small share of neck movement, and most people do not notice it in daily life. Fusing several levels has more effect, which is one reason disc replacement is considered where it suits.
Usually one night. Some people go home the same day, and some stay longer if swallowing is uncomfortable or more than one level was treated.
The windpipe and gullet are held gently aside during the operation, and a breathing tube is used. Both leave the throat sore for a few days, and swallowing can feel awkward for a week or two.
Driving once you are off strong painkillers and can turn your head comfortably, usually around two weeks. Desk work in two to four weeks; heavier work six to twelve weeks.
Rarely. Modern implants are titanium and are usually not picked up. You do not need a card or letter, though some people prefer to carry one.
No. Bring your MRI images and report, any X-rays, and a note of what treatment you have already tried.
Cervical radiculopathy · Cervical myelopathy · Cervical spondylosis · Slipped disc · Neck pain · Decompression surgery
Bring your MRI. Most conversations about ACDF start with whether surgery is needed at all, and which operation fits your neck.
