Recovery after ACDF Surgery

Anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed neck surgeries. The ACDF surgery is done to relieve symptoms associated with compression of the spinal cord or the spinal nerves in the cervical region. The recovery after ACDF surgery may vary from patient to patient due to different baseline health and the type of ACDF surgery performed,

The ACDF helps to relieve symptoms such as neck pain, numbness and tingling in the arms, shoulders, or hand, shooting pain in the arms, weakness of hands, or lower extremities. During the surgery, the spine surgeon accesses the cervical vertebrae from the front of the neck.

The surgeon removes the diseased intervertebral disc and any tissues that compress the neural structures. A bone graft is usually placed along with a prosthetic bone cage to maintain the disc space and help in the union.

Immediately after the surgery, the patient is usually managed in the recovery area and post-operative pain is managed with medication. The patient may be able to go home the same day after the surgery or the next day depending upon the extent of the surgery and patient risk. The patients are motivated to sit and walk after the surgery.

At home, the patients are usually advised to wear a neck collar to prevent sudden turning or bending movement. The neck collar may be taken off while eating or taking a shower. The post-operative pain is usually managed with opioid analgesics and the patient is slowed weaned off the analgesics in two weeks.

The patients are advised to stay active in the form of walking and moving but with precautions to not lift objects more than 5 pounds, bending, or turn quickly. The patients are also advised to report any warning signs during the initial post-op period.

The warning signs may be increasing numbness, tingling or weakness of the upper or lower extremities, swelling of the arms/feet, loss of bowel bladder control, pain, swelling, redness, or discharge from the incision site.

Some common symptoms patients may experience after the ACDF surgery include sore throat, hoarseness, pain, difficulty speaking and difficulty swallowing. The symptoms usually get better in the first month.

The hoarseness and difficulty speaking are attributed to the retraction of the recurrent laryngeal nerve that supplies the voice box situated on top of the windpipe. Similarly, retraction of the food pipe and the muscles around the food pipe may cause symptoms of difficulty swallowing and sore throat after ACDF.

Constipation is a common symptom immediately following ACDF surgery. Constipation may also result from the use of opioid analgesics for pain. The patients are advised to enrich their diet with fibers and increase their dietary intake of water.

The patients are advised a liquid diet during the initial recovery period to help with the symptoms of difficulty swallowing. The patients are also advised to keep phonation at a minimum and speak softly to help with difficulty speaking and hoarseness. The difficulty swallowing and speaking may require late in patients with multi-level fusion who generally have a prolonged surgery time.

At 4 weeks post-op, the fusion of the adjoining vertebrae has significantly progressed with a solid construct only at 3 months post-op. The fusion continues to progress into a stronger construct 1-year post-op. The patient at 4 weeks post-op are allowed more activities and after an assessment, the surgeon may recommend physical therapy.

Physical therapy is aimed at strengthening the muscles around the neck and also increasing the flexibility of the neck. Physical therapy also allows workplace assessment and the suitability of the patient to return to work. Physical therapy also helps to train patients to maintain a correct posture and balance and avoid certain motions/activities.

The patients may be allowed to participate in low-impact activities such as golf and tennis but impact sports may still be prohibited. The majority of the patients return to work at 4 weeks but some patients may return earlier depending upon the type of work and the extent of the ACDF surgery.

Along with posture precautions, smoking cessation forms an important part of the recovery. Continued smoking delays the healing of the fusion construct and may even lead to nonunion of the fusion. Smoking is also associated with increased post-op complications and continued neck pain.

The majority of the patients are quickly able to get back to the activities they enjoy following the rehabilitation after ACDF surgeries. Some patients may require special rehabilitation protocols depending upon the disease status prior to the surgery and the extent of the surgery.