From the Guidelines
Anterior Cervical Discectomy and Fusion (ACDF) for a Prolapsed Intervertebral Disc (PIVD) at C5-C6 is a surgical procedure that should be performed with an anterior approach, as it poses less morbidity to the patient in terms of muscle manipulation and wound healing, as stated in the 2016 IDSA clinical practice guideline 1. The procedure begins with general anesthesia administration and patient positioning supine with slight neck extension.
- A transverse incision is made along a skin crease on the right or left side of the neck at the C5-C6 level, typically 3-4 cm in length.
- The platysma muscle is divided, and the surgeon develops a plane between the sternocleidomastoid muscle laterally and the trachea and esophagus medially.
- The prevertebral fascia is identified and incised to expose the anterior spine.
- Retractors are placed to maintain exposure, and the correct level is confirmed with fluoroscopy. The anterior longitudinal ligament is incised, and the intervertebral disc at C5-C6 is removed using rongeurs and curettes, including the cartilaginous endplates, as recommended in the anterior surgical approach section of the guideline 1.
- Posterior osteophytes are removed with a high-speed drill or rongeurs.
- The posterior longitudinal ligament is opened to ensure complete decompression of the spinal cord and nerve roots. A bone graft, preferably autologous bone harvested from the iliac crest or the ribs, should be used as graft material, as it is probably the best option whenever possible, according to the guideline 1.
- A cage filled with bone substitute can also be used as an alternative.
- An anterior cervical plate with screws is applied to provide immediate stability.
- Hemostasis is achieved, and the wound is closed in layers with absorbable sutures for deep tissues and either absorbable sutures or staples for skin. Postoperatively, patients typically wear a cervical collar for 4-6 weeks and undergo physical therapy, which helps in achieving a mature bony fusion that provides a durable and physiologically dynamic support system, protecting the neural structures and decreasing mechanical pain, as stated in the guideline 1.
From the Research
Procedure Overview
The Anterior Cervical Discectomy and Fusion (ACDF) procedure at the C5-C6 level involves several steps:
- Removal of the disc material to achieve neural tissue decompression 2
- Placement of a bone graft or interbody implant to promote fusion 2, 3
- Stabilization of the spinal column using a cervical plate and screws 2, 3
Step-by-Step Procedure
The steps involved in the ACDF procedure at the C5-C6 level are:
- Incision and exposure of the C5-C6 level 4
- Discectomy and removal of the herniated disc material 5
- Decompression of the neural tissue 2
- Preparation of the endplates for fusion 6
- Placement of a bone graft or interbody implant, such as a PEEK anatomical cervical cage and allograft bone 6
- Stabilization of the spinal column using a cervical plate and screws 2, 3
- Closure of the incision 4
Postoperative Care
After the ACDF procedure, patients are typically monitored for any complications and undergo routine imaging to assess fusion and spinal alignment 3. The expected outcomes of the procedure include: