Anterior Cervical Discectomy & Fusion (ACDF) for Neck Pain

Daily activities may transform from easy to difficult if you experience chronic neck and arm pain. For many, this pain — caused by herniated discs, spinal cord compression, or injury — can feel unbearable. But a cervical discectomy may be the lasting antidote to your pain. 

Anterior cervical discectomy and fusion (ACDF) is a spine surgery procedure that removes damaged discs and fuses the neighboring vertebrae, relieving pressure on the nerves in your neck¹. This procedure can significantly reduce pain and improve function, but is it the right option for you?

In this comprehensive guide, you’ll learn about the ACDF procedure — including its risks and benefits — who makes a good candidate, how to find the right surgeon, and what to expect before, during, and after surgery. 

What is Anterior Cervical Discectomy and Fusion Surgery?

Anterior cervical discectomy and fusion surgery can be used to treat chronic neck and arm pain stemming from the cervical spine. The cervical spine is made up of muscle, vertebrae, and discs that are all critical to enabling neck movement, supporting your head, and protecting the nerves that connect your brain to the rest of your body¹.

But injuries, herniated discs, and underlying conditions like arthritis or degenerative disc disease can damage the cervical spine and compress nearby nerves. This can lead to symptoms like severe neck and arm pain, difficulty balancing, and weakness, tingling, or numbness in your arms, hands, or fingers².

Sometimes, the underlying cause of your nerve pain can be successfully treated with physical therapy, medications, or injections. But if these treatments don’t help, it may be time to consider ACDF surgery, says Leonel Hunt, MD, a Commons Clinic orthopedic spine surgeon.

ACDF surgery usually takes about one to two hours, and you can often return home the same day. During surgery, your surgeon makes a small incision at the front of your neck, removes the disc (or discs) compressing your nerves, and connects the adjacent vertebrae with hardware so they can grow into one solid, stable bone. 

You should be able to resume most everyday activities about three to six months after your surgery, though it typically takes about one year for your vertebrae to fully fuse, according to Dr. Hunt. While you may notice decreased neck flexibility during your recovery, you should also experience significant pain relief right away.

Benefits of Anterior Cervical Discectomy and Fusion

ACDF surgery can be highly effective — in fact, 85% to 95% of people who received the procedure reported that it was a success, according to a February 2018 study in Spine³. Here’s why:

It’s a minimally invasive approach.

ACDF is a minimally invasive surgery, which means that it requires smaller incisions and causes less scarring and damage, says Dr. Matthew Griffith, an orthopedic surgeon at the Hughston Clinic and member of the North American Spine Society. All of this can contribute to a faster recovery with fewer complications.

Compared to more invasive surgeries that require larger incisions and can damage surrounding tissues, ACDF involves a small, 1- to 2-inch cut at the front of the neck. During the procedure, a device holds muscle and soft tissue aside to minimize trauma to the rest of your neck, according to a December 2018 study in Acta Neurochirurgica⁴.

It can relieve pain—fast.

By decompressing the nerves in your cervical spine, ACDF surgery can directly address the root cause of your pain and provide immediate and more lasting relief, says Dr. Hunt.

In fact, according to a July 2017 study in Spine, people reported a 49.2% to 55.1% reduction in arm pain in the first year after surgery⁵. And a March 2019 study in Global Spine Journal found that people experienced a 50% to 60% reduction in neck pain in the four years following the procedure⁶.

It can encourage new bone growth.

During ACDF surgery, your surgeon stabilizes the affected vertebrae with bone grafts and screws, plates, or rods⁷. These hold the vertebrae in place, supporting your spine as it begins the healing process.

As you recover, new bone cells will gradually form around the hardware, allowing the vertebrae to fuse into a single bone. This fusion helps improve spinal stability and prevent pain in the long term².

It can prevent further spinal issues.

ACDF surgery addresses the root cause of your neck pain by taking the pressure off of your nerves. This can stop or limit the progression of nerve-related issues, which, if left untreated, can lead to permanent damage².

ACDF also improves your cervical spine stability. This allows for better spinal function and sensation, which can help stop or limit the progression of chronic conditions like degenerative disc disease². More spinal stability can also help reduce your risk of future injury.

It can improve your quality of life.

Altogether, ACDF surgery can have a major impact on your quality of life. By reducing everyday pain and preventing worsening spinal problems, many ACDF patients are able to return to activities, work, and functionality that wasn’t previously possible.

“It’s one of the most gratifying surgeries we do because it’s a straightforward procedure that addresses pain that’s so debilitating,” Dr. Hunt says. “Patients will wake up and feel so great.”  

Who is a Candidate for Anterior Cervical Discectomy and Fusion?

ACDF surgery is generally recommended for more serious spinal conditions and isn’t necessary for routine neck pain. Here are some key indicators that the procedure might be a suitable option for you:

• You have a spinal condition: “The number one patient that’s a candidate for ACDF is someone who has neck pain as well as arm pain with weakness, numbness, and tingling,” Dr. Hunt says. “Spinal cord compression and trauma, like fractures that need stabilizing, can also be addressed with ACDF.” ACDF is also used to treat herniated discs, degenerative disc disease, bone spurs, pinched nerves, and spine injuries. 
• Your condition is getting worse: Some chronic, underlying conditions like degenerative disc disease or cervical spinal cord compression (also called cervical myelopathy) continue to worsen over time. However, ACDF surgery can help end or reduce the nerve pain these conditions may cause².
• Other treatments don’t work: “Give [other treatments] an adequate amount of time, at least a couple of months or more,” Dr. Hunt says. “But if you’ve done a couple months of physical therapy, you’ve tried acupuncture, you’ve tried anti-inflammatories, and none of those things have helped, it’s time to consider surgical intervention.” 

While ACDF surgery can be a highly effective option under these circumstances, it’s essential to consult with your physician to determine if it’s right for you. They can assess your unique symptoms and medical history to ensure you make the best, most informed choice for your health and long-term wellbeing.

Preparing for Surgery

If you and your doctor have determined that ACDF surgery is the best option, there are some steps you can take before the procedure to set yourself up for optimal results. Preparing ahead of time can not only improve the success of your surgery but make your recovery smoother and less stressful.

From selecting the right surgeon to learning what to expect the day of your surgery, planning ahead is key. Take these steps to ensure you feel comfortable and prepared throughout the process. 

1. Find the right surgeon.

It’s important that you feel comfortable with the surgeon performing the procedure. If you’re not sure where to begin looking, ask your primary care doctor for referrals to spine specialists who have experience with ACDF⁸.

That said, “don’t just ask referring physicians,” Dr. Hunt advises. “The most important thing is to ask around — people have reputations for a reason. Everybody knows someone who’s had back surgery, so talk to your friends and see who people are talking about.”

Once you’ve gathered a few options, do some background research. Visit each surgeon’s online profile to see their experience, areas of specialization, patient reviews, and whether they’re fellowship-trained and board-certified⁸.

Then set up a consultation with your favorites. You can use this time to get their opinion on your diagnosis and treatment plan, ask specific questions, and learn what to expect during surgery. Dr. Hunt says no questions are off-limits, so feel free to bring up anything that’s on your mind. Here are some to get you started⁸:

• What is your diagnosis for my symptoms? And what is the best way to treat them?
• How long have you been practicing?
• What are the outcomes of your ACDF procedures, like the rates of infection and readmission?
• Have you participated in any clinical research about my condition or the ACDF procedure?
• What are the risks and benefits of this procedure?
• What can I expect before, during, and after surgery?

Expertise isn’t the only mark of a good surgeon — it’s also about whether or not you feel comfortable with them.

“Any competent spine surgeon should be able to do ACDF. But will they answer your questions, will they be available if something goes wrong, will they answer your calls, and are you comfortable and confident in them?” Dr. Hunt says. “We’re a team: I’m half the team, and the patient is the other half. You have to feel confident your surgeon is on your journey with you.”

2. Stop smoking.

Once you’ve settled on a spinal surgeon, it’s time to start preparing for your procedure. One of the best things you can do to set yourself up for success? Quit smoking.

According to a November 2017 study in the International Journal of Spine Surgery, smoking ups your risk for complications during and after surgery, including infection, further spinal degeneration, and difficulty swallowing⁹. Tobacco and nicotine use can also interfere with healthy bone fusion and recovery, Dr. Griffith says.

Surgeons typically recommend ending smoking for the four to six weeks leading up to the surgery, and remaining smoke-free for at least six weeks after¹⁰.

3. Discuss your medications and supplements.

Some medications, such as blood thinners, can elevate the risks associated with surgery. It’s important to give your surgeon a complete list of all prescription drugs, over-the-counter medications, supplements, and vitamins you are currently taking ahead of your procedure¹.

They’ll let you know if you need to temporarily stop taking any medications or supplements and for how long.

4. Follow pre-surgery instructions.

Your surgeon will provide guidelines on what to eat and drink, what activities or medications to avoid, and other important information in the days leading up to the procedure¹¹. Follow these carefully to reduce surgical risks.

They’ll also brief you on what to expect on the day of your surgery and throughout the recovery process so you can make the necessary arrangements to get home after the procedure and receive the aftercare you need.

The Anterior Cervical Discectomy and Fusion Process

On the day of your surgery, you’ll arrive two to three hours beforehand to get your vitals checked and place your IVs, Dr. Griffith says. You may also be given anti-anxiety medication to relax you prior to entering the operating room.

When it’s time for your procedure, you’ll be given general anesthesia. The surgery typically takes one to two hours, and there are four main steps:

1. The approach: During this phase of surgery, your surgeon makes a small incision at the front of your neck, typically in one of your existing neck creases, Dr. Griffith says. Then, they’ll move your soft tissue aside to approach the affected part of your spine without disrupting other parts of your neck.
2. The discectomy: Next, your surgeon will remove the damaged disc (or discs) to relieve pressure on your nerves and spinal cord.
3. The fusion: “After the nerves and spinal cord are decompressed, a [fusion] cage filled with bone graft is placed in the disc space with a plate placed over the front,” Dr. Griffith explains.
4. The closure: Your surgeon will seal the incision in your neck and move you to the recovery room.

What to Expect After Surgery

ACDF surgery is only the first step in your healing process, so understanding what to expect next can help ensure a smoother recovery. Here’s a look at the stages of recovery, along with the support and follow-up care you’ll need for the best possible outcomes.

Immediately after surgery

You’ll wake up in a recovery room, where healthcare professionals will monitor vitals like blood pressure, heart rate, and respiration as the anesthesia wears off. You’ll also be given pain medication as needed².

Once you’re awake, you’ll gradually begin gentle activities like sitting up and walking.

The week after surgery

Your initial recovery period can be rapid — if you only have one disc removed, you can typically return home the same day, Dr. Griffith says. Before going home, you’ll receive detailed post-operative instructions, including how to manage pain, signs of infection to look out for, and follow-up care recommendations. For procedures involving multiple discs, you may need to stay in the hospital for an extra day or two.

Once you’re home, you’ll likely feel tired and sleepy for the first week as your body recovers from anesthesia and begins the healing process, according to Dr. Hunt. “People can expect to have some soreness and a bit of difficulty swallowing for the first week or so,” he adds. “I recommend eating softer foods, chewing food well, and washing it down with water.”

He also recommends walking as much as you can in the first weeks after your surgery to encourage strength, mobility, and recovery.

Six weeks after surgery

While you should start walking as soon as you return home, the first six weeks of recovery are typically the most limiting. You can participate in light everyday activities, but according to Dr. Hunt, here’s what to avoid doing during that time:

• Lifting anything heavier than five pounds
• Lifting anything over your head
• Twisting or bending your neck, with the exception of light side-to-side and up-and-down motions (like nodding your head “yes” or “no”)
• Bending over, which allows your head to hang and puts undue stress on the neck
• Wearing a neck brace or collar, which can weaken your neck muscles

Three months after surgery

Typically, says Dr. Hunt, you can return to your normal everyday activities around the three- to six-month mark, assuming you’re healing appropriately.

However, your exact recovery timeline will vary depending on factors like your overall health and how well your body responds to the surgery. Your surgeon will monitor your progress throughout your recovery and provide personalized guidance on when it’s safe to resume specific activities.

In the meantime, take care to avoid high-impact or dangerous activities—like climbing, motorcycling, and contact sports—until your bones have fully healed, which usually takes about a year, says Dr. Hunt.

Aftercare

Follow-up visits

Follow-up visits are essential to monitor your progress and ensure a healthy recovery. You’ll have about six appointments, during which your surgeon will check for signs of infection, make sure your bones are fusing properly, and discuss any concerns you may have. 

According to Dr. Hunt, your post-operative appointment schedule usually involves:

• A wound check 10 days after surgery
• X-rays six weeks after surgery
• A three-month check-in
• A six-month check-in
• A one-year check-in
• A two-year check-in

If you need additional care or want to consult with your doctor between appointments, you can always schedule extra visits, Dr. Hunt adds. 

Rehabilitation

Your doctor may also recommend that you start physical therapy about four to six weeks after surgery¹. Rehabilitation exercises focus on restoring strength and mobility in the neck, reducing stiffness, and preventing future complications. 

Commons Clinic provides comprehensive care that includes post-surgical physical therapy tailored to your recovery needs. Common exercises, such as neck stretches, chin tucks, shoulder shrugs, and chair press-ups, may be part of your therapy to help you regain full function and prevent further issues.

Your care team may also recommend additional lifestyle adjustments, like avoiding NSAID medications for a period of time and quitting smoking, according to Dr. Griffith.

Risks and Complications of ACDF Surgery

ACDF is generally safe and has high success rates, but all surgeries carry some risks. These risks can vary based on factors like your age, health status, and medical history, so be sure to talk with your doctor beforehand if you have any concerns.

Here are some general potential surgical complications to be aware of¹:

• Infection 
• Fever
• Bleeding
• Blood clots
• Reaction to anesthesia

Additional potential complications that are specific to cervical discectomy and fusion include⁷: 

• Damage to the recurrent laryngeal nerve, which can cause hoarseness, trouble swallowing, and neck pain
• Bone graft rejection
• Nerve damage
• Ineffective spinal fusion
• Movement of the bone graft or the screws and plates holding it in place
• Transitional syndrome (this is when neighboring vertebrae begin to degenerate from the stress of the nearby fusion)

Though it’s rare, you may need additional revision surgeries to repair issues with the fusion hardware¹².

Success Rates and Outcomes

ACDF is a highly successful way to treat relevant cervical spine issues, with 85% to 95% of people reporting a successful outcome, according to a 2018 Spine study³. In other words, ACDF typically provides significant pain relief and functional improvement.

Dr. Hunt highlights the profound impact ACDF can have on quality of life, noting that, in some cases, this procedure can mean the difference between being able to work and not working at all.

“We operated on someone who had a herniated disc in his neck from a bad bike accident,” he says. “Fast forward, and he was able to finish his residency, did a fellowship, and is now a thriving plastic surgeon because of it.”

Frequently Asked Questions (FAQs)

What is a cervical discectomy?

Cervical discectomy is a surgery to remove a damaged disc (or discs) in your neck in order to relieve nerve pressure and pain¹. Cervical discectomies can also be paired with a fusion, which is when your surgeon connects the vertebrae on either side of the removed disc so they can grow into one solid, stable bone. 

What is the recovery time for a cervical discectomy?

You can typically go home the same day of your procedure—just avoid lifting things heavier than five pounds, holding things over your head, and twisting or bending your neck for the first six weeks. You can expect to be back to most of your normal activities about three to six months after the procedure, though you should continue to avoid high-impact or dangerous activities for about one year while the affected vertebrae finish healing.

How painful is a cervical discectomy? 

You’ll be under general anesthesia during the procedure, so you won’t feel a thing. Afterwards, it’s common to experience some pain (often between your shoulder blades or across your upper back), soreness, and difficulty swallowing in the week following your surgery.

Is a cervical discectomy the same as fusion? 

A cervical discectomy is just one part of the ACDF procedure. The discectomy portion involves removing the affected disc, and the fusion part of the procedure stabilizes your spine by connecting the vertebrae on either side of the affected disc².

What can you not do after a cervical discectomy?  

Avoid twisting or bending your neck (besides the “yes” and “no” motions), bending over, lifting anything that’s more than 5 pounds, holding things over your head, and wearing a neck brace during the first six weeks of your recovery. Don’t smoke, as it can disrupt bone healing. Some surgeons may also suggest that you avoid NSAID medications until your bone is fully healed. 

Conclusion

ACDF surgery can be an effective solution for those struggling with chronic neck pain, arm pain, and other nerve-related symptoms due to conditions like degenerative disc disease, herniated discs, or injury. By decompressing nerves in your cervical spine, ACDF can quickly alleviate pain, improve mobility, stabilize the spine, and stop or limit the progression of degenerative conditions. 

Recovery from ACDF surgery requires some time and care, but you’ll typically resume normal activities within three to six months. For many people, this procedure leads to a dramatic improvement in quality of life, restoring your ability to work, engage in daily activities, and live with less pain. Considering ACDF? Set up a visit with one of the Commons Clinic’s top-ranked spinal specialists to have all your questions answered, explore the benefits and risks of the procedure, and get an expert opinion on whether it’s the best option to relieve your symptoms.

Sources

¹ Cleveland Clinic. “Anterior Cervical Discectomy and Fusion (ACDF).” https://my.clevelandclinic.org/health/procedures/acdf-surgery#recovery-and-outlook 

² Washington University Neurosurgery. “Anterior Cervical Discectomy and Fusion (ACDF) Surgery Guide.” (2023). https://neurosurgery.wustl.edu/wp-content/uploads/2023/09/ACDF.pdf 

³ Butterman, G. “Anterior Cervical Discectomy and Fusion Outcomes over 10 Years: A Prospective Study.” Spine. (2018). https://pubmed.ncbi.nlm.nih.gov/28604488/ 

⁴ Vergara, P., and Timofeev, I. “Minimally invasive anterior cervical discectomy and fusion: a valid alternative to open techniques.” Acta Neurochirurgica. (2018). https://pubmed.ncbi.nlm.nih.gov/30417202/

⁵ Massel, D., et al. “Improvements in Neck and Arm Pain Following an Anterior Cervical Discectomy and Fusion.” Spine. (2017). https://pubmed.ncbi.nlm.nih.gov/27851659/ 

⁶ Oitment, C., et al. “The Role of Anterior Cervical Discectomy and Fusion on Relieving Axial Neck Pain in Patients With Single-Level Disease: A Systematic Review and Meta-Analysis.” Global Spine Journal. (2019). https://pmc.ncbi.nlm.nih.gov/articles/PMC7160803/ 

⁷ Northwestern Medicine. “Anterior Cervical Discectomy and Fusion (ACDF).” https://www.nm.org/conditions-and-care-areas/treatments/anterior-cervical-discectomy-and-fusion 

⁸ American Academy of Orthopaedic Surgeons. “Finding the Right Orthopaedic Surgeon.” https://orthoinfo.aaos.org/en/treatment/finding-the-right-orthopaedic-surgeon/ 

⁹ Berman, D., et al. “The Effect of Smoking on Spinal Fusion.” International Journal of Spine Surgery. (2017). https://pmc.ncbi.nlm.nih.gov/articles/PMC5779238/ 

¹⁰ American Academy of Orthopaedic Surgeons. “Smoking Cessation: Tools for Success.” https://www.aaos.org/quality/quality-programs/quality-toolkits/smoking/ 

¹¹ Johns Hopkins Medicine. “Minimally Invasive Spinal Fusion.” https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/minimally-invasive-spinal-fusion 
¹² Song, Kyung-Jin et al. “Prognosis of Hardware-Related Problems in Anterior Cervical Discectomy and Fusion with Cage and Plate Constructs.” World Neurosurgery. (2020). https://pubmed.ncbi.nlm.nih.gov/31629142/