Procedures in San Francisco CA
Anterior Cervical Discectomy and Fusion (ACDF)
Anterior cervical discectomy and fusion (ACDF) is a workhorse of the surgical treatment of spinal conditions. It is used to treat anything from spinal cord compression (myelopathy), nerve root compression, radiculopathy, or axial neck pain due to degenerative disc disease. It can be used for any combination of the above. ACDF has been used successfully since the original description of the approach by Smith and Robinson and the development of the technique by Cloward.
Over the years, both the ACDF surgical technique and the implants have been perfected. To maximize neurological safety, we use a surgical operating microscope (Leica or Zeiss), neuromonitoring for cases of spinal cord compression. The ACDF procedure involves usually a left-sided approach, which essentially removes the anatomic structure without violating any of the muscles. It follows the interval between the trachea and esophagus in the middle and the carotid sheath off to the side to approach the cervical spine. ACDF is one of the most successful operations in spine surgery in particular, and in all orthopaedic surgery and neurosurgery.
A one-level procedure can occasionally be done on an outpatient basis. The success rates for the ACDF surgery are very high for any kind of surgical procedure and range anywhere from 80% to 90%. Occasionally, bracing is necessary, especially for smokers or patients who undergo multilevel procedures. At St. Mary’s Spine Center, we have been using zero-profile standalone devices, which minimize the risks of postoperative swallowing and speech difficulties, as well as minimize the chance of adjacent-segment disease.
Anterior Cervical Corpectomy and Fusion (ACCF)
Anterior cervical corpectomy and fusion (ACCF) differs from anterior cervical discectomy and fusion (ACDF) in how much of the bone is normally resected. In the case of ACDF, only bone spur is resected at the level of the disc. In the case of ACCF, at least part of the vertebral body or the whole vertebral body is resected. This is usually necessary for conditions that involve ossification of the posterior longitudinal ligament (OPLL), a condition that is more common in Asians and can cause spinal cord compression. Also, it is sometimes utilized for tumors and infections. In other respects, it is very similar to ACDF.