ACDF
The disc is removed from the front of the neck, the pressure is taken off, and the level is fused with a spacer. The most established cervical operation there is.
About ACDF ›Cervical spine surgery: what each operation does
Neck surgery has one job: taking pressure off a nerve or the spinal cord. This page explains what each operation actually involves, who it suits, what it will not fix, and how the choice between them is made.
One job
Relieving pressure on a nerve or the spinal cord. That is what these operations do well.
Not for neck pain alone
Surgery is unreliable for neck pain that has no nerve or cord compression behind it.
Front or back
The approach follows where the pressure is coming from, not surgeon preference.
Last resort
Except for cord compression, an operation comes after non-surgical treatment has been given a fair go.
THE OPERATIONS
Three procedures cover most cervical nerve compression
Which one suits you depends on where the compression is, how many levels are involved, and your own anatomy. All three are well established and all three have good evidence behind them.
Cervical disc replacement
The same front approach, but the disc is replaced with a mobile artificial one instead of fusing. Preserves movement at that level in suitable patients.
About disc replacement ›Posterior foraminotomy
A smaller operation from the back of the neck that opens the tunnel the nerve exits through. No implant, no fusion, quicker recovery.
About foraminotomy ›For more extensive cord compression across several levels, operations from the back of the neck such as laminectomy and laminoplasty, or a corpectomy from the front, may be more appropriate. These are discussed individually where they apply to you. Cervical myelopathy covers the situations in which they are considered.
HOW THE CHOICE IS MADE
The anatomy decides more than the preference does
There is rarely one correct operation and several wrong ones. More often there is a shortlist, and the discussion is about which trade-offs suit you.
FIRST
Where is the pressure?
Compression in front of the nerve or cord usually points to an approach from the front. Compression from behind, or across many levels, points to the back.
THEN
How many levels?
One or two levels can usually be dealt with from the front. Three or more, or a long stretch of narrowing, is often better addressed from behind.
THEN
Nerve or cord?
A single trapped nerve root opens up options including foraminotomy. Cord compression narrows the field to operations that reliably decompress the canal.
FINALLY
You
Age, neck alignment, whether you smoke, previous surgery and what you need your neck to do all shift the balance between the options.
If a surgeon proposes an operation, it is entirely reasonable to ask why that one rather than the alternatives, and what would change the recommendation. A clear answer to that question is a good sign. ACDF compared with disc replacement sets out the most common of those decisions in detail.
BEFORE YOU GET THERE
What has to be true before surgery is on the table
1
Something is being compressed
A nerve root or the spinal cord, confirmed on imaging and matching your examination. Not just wear and tear on a report.
2
The compression explains your symptoms
The level involved has to correspond to what you actually feel. Operating on the wrong level fixes nothing.
3
Non-surgical treatment has had a fair go
Except where the cord is at risk or weakness is progressing, in which case waiting is the greater risk.
4
The likely gain justifies the risk
Every operation has risks. They are worth accepting when the problem being treated is worse, and not otherwise.
The exception
Significant spinal cord compression is the situation where waiting carries its own risk, because function lost to cervical myelopathy does not reliably return. Rapidly worsening weakness, new clumsiness in both hands, or any change in bladder or bowel control needs emergency assessment: call 000 or attend your nearest emergency department.
HONESTLY
What neck surgery does not do
It is not a treatment for neck pain
Where there is no nerve or cord compression, surgery is unreliable for neck pain. Arm pain from a trapped nerve responds well; neck pain alone often does not. Anyone promising otherwise is overstating the case.
About neck pain ›It does not stop your neck ageing
An operation addresses one or two levels. The rest of the neck carries on changing with age, and a fused level places a little more demand on its neighbours. That is a known trade-off, not a complication, and it is part of the discussion.
About spondylosis ›Most people with a cervical spine problem do not need an operation. Non-surgical treatment is covered separately.
Weighing up an operation, or a recommendation you have already been given?
A consultation will tell you whether surgery is warranted, which operation fits your anatomy, and what to expect either way. You will need a referral from your GP or another specialist for a Medicare rebate.