Which specialist performs an anterior cervical fusion?

Anterior Cervical Fusion Specialists

Anterior cervical fusion procedures are primarily performed by neurosurgeons and orthopedic spine surgeons who have specialized training in spine surgery. 1

Specialist Qualifications and Training

• Neurosurgeons: Complete medical school followed by a 7-year neurosurgical residency with specific training in spine procedures
• Orthopedic Spine Surgeons: Complete medical school followed by a 5-year orthopedic surgery residency plus an additional 1-2 year spine fellowship

Both specialists are equally qualified to perform anterior cervical fusion procedures, with the choice often depending on:

• Local referral patterns
• Surgeon availability
• Specific case complexity
• Patient preference

Procedure Overview

Anterior cervical discectomy and fusion (ACDF) involves:

1. Surgical approach through the anterior neck
2. Removal of the damaged disc material
3. Decompression of neural elements
4. Placement of bone graft or interbody implant
5. Application of cervical plate and screws for stabilization 2

Specialist Selection Considerations

When to Consider a Neurosurgeon

• Cases with significant spinal cord compression
• Patients with myelopathy
• Complex revisions of failed anterior cervical fusions
• Cases requiring direct neural decompression

When to Consider an Orthopedic Spine Surgeon

• Cases focused primarily on biomechanical stability
• Multi-level fusions requiring extensive reconstruction
• Cases with significant bony abnormalities

Surgical Approach Expertise

Both specialists are trained in the standard Smith-Robinson approach used for ACDF procedures 3. This involves:

• Careful dissection through anterior neck structures
• Retraction of the trachea and esophagus medially
• Retraction of the carotid sheath laterally
• Identification and protection of the recurrent laryngeal nerve

Complication Management

Both specialists are trained to manage potential complications including:

• Dysphagia (9.5% of cases)
• Postoperative hematoma (5.6%)
• Recurrent laryngeal nerve palsy (3.1%)
• Dural penetration (0.5%)
• Esophageal perforation (0.3%) 3

Special Considerations for High Cervical Fusions

For C2-C3 fusions, which are technically more demanding:

• Both specialists can perform these procedures
• Higher complication rates are reported (dysphagia in 36% of cases)
• Specialist experience with high cervical anatomy is particularly important 4

Revision Surgery Expertise

For pseudarthrosis (failed fusion) cases:

• Both specialists can perform revision procedures
• Anterior revision approaches show 76% fusion rates
• Combined anterior-posterior approaches show 94-100% fusion rates
• Specialist selection may depend on the specific approach needed 1

Key Takeaway

While both neurosurgeons and orthopedic spine surgeons are qualified to perform anterior cervical fusion procedures, the most important factor is selecting a surgeon with specific training and experience in spine surgery, regardless of their primary specialty background.