Getting Familiar with the Complications of ACDF Surgery
15 Jul, 2022
Overview
Every other surgery or procedure carries several risks and complications. But, even if the risk is low for some surgeries, you should not overlook the minute chances of developing serious complications. Here we’ve discussed the complications of anterior cervical discectomy and fusion surgery. Keep reading to learn the same.
Why do you need to undergo ACDF surgery?
Anterior cervical discectomy and fusion are usually recommended for patients who have cervical spondylosis or disc herniation with myelopathy/radiculopathy that is
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unresponsive to conservative therapy. Additionally, it may be indicated in certain malignant, traumatic, or infectious processes of the cervical vertebrae that cause instability.
How is ACDF surgery done?
The procedure is performed through an anterolateral neck incision, with the surgical approach passing medially between the aerodigestive tract (trachea, esophagus, pharyngeal muscles) and laterally between the carotid neurovascular bundle (carotid artery, internal jugular vein, vagus nerve).
The intervertebral disc and the fibrocartilage covering the adjacent vertebral endplates are then removed (to allow for eventual osseous fusion). Reaching back to the posterior longitudinal ligament, removing osteophytes and disc protrusions as well as extending laterally to decompress the neural exit foramina, is possible.
Following decompression, an interbody spacer of some kind is introduced to aid fusion/improve stability.
After that, an anterior cervical plate with screws that pass into the vertebral bodies above and below the operative segment is typically used to provide additional stability.
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Newer devices combine screw fixation and interbody spacing into a single device that fits entirely within the interbody space and does not require the added bulk of the anterior plate.
Also, Read - Types of Spine Surgeries and their Implications
What are the complications associated with ACDF surgery?
As per our spine surgeon, the following are the complications associated with ACDF surgery.
- Hemorrhage or wound hematoma formation
- Damage to the carotid or vertebral artery can cause a stroke, excessive bleeding, and even death.
- Hoarseness is caused by damage to the recurrent laryngeal nerve.
- Damage to the superior laryngeal nerve causes swallowing problems.
- Infection caused by esophageal or tracheal damage
- Dura damage causes a cerebrospinal fluid leak or a pocket of cerebral spinal fluid beneath the incision
- Mechanical graft and plate complications (including graft migration, breakage of the plate, screw pullout, etc.)
- Infection of the wound
- Painful pseudoarthrosis develops (failure of adequate fusion to occur)
- Spinal cord or nerve root(s) damaged resulting in pain, weakness, paralysis, loss of sensation, loss of bowel or bladder function, and impaired sexual function
Post-operative care for ACDF surgery:
- The lateral cervical radiograph is a common way to assess prevertebral soft tissue swelling after such surgery.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated because they inhibit bone formation, which is required for the fusion to take hold. The same is true for all tobacco products.
- External bone stimulators could theoretically be used to aid fusion formation in selected patients who are at high risk of poor fusion.
- The spine surgeon may prescribe a cervical collar for a specific period to aid in postoperative healing and avoid extremes of neck range of motion. The spine surgeon will also advise the patient on specific lifting and activity restrictions during the post-op period.
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