What are the post-operative instructions for a patient who has undergone an Anterior Cervical Discectomy and Fusion (ACDF) surgery?

Post-Operative Instructions for ACDF Patients

Immediate Post-Operative Period (First 24-48 Hours)

You should be monitored closely for neurological changes, including any new weakness, numbness, or changes in sensation in your arms or hands during the first 24-48 hours after surgery. 1

• Any concerning neurological symptoms require urgent evaluation with CT followed by MRI to rule out serious complications such as hematoma formation 1
• Surgical site hematoma causing compression may require immediate return to the operating room for evacuation 1
• Most patients can safely be discharged the same day or within 23 hours for single or two-level ACDF procedures, with complication rates as low as 1.4% in appropriately selected patients 2

Activity Restrictions and Cervical Collar Use

You do not require a rigid cervical collar after single-level ACDF, as clinical outcomes and fusion rates (94%) are excellent without collar use. 3

• Single-level ACDF without collar immobilization achieves comparable fusion rates to plated procedures while allowing faster return to activities 3
• Hospital stays average 1.76 days, with most patients discharged within 24 hours 3, 2
• You can expect faster return to work and driving with plated ACDF compared to non-plated procedures 4

Pain Management and Functional Recovery

You should experience rapid relief of arm pain, neck pain, and weakness within 3-4 months, with 80-90% success rates for arm pain relief. 1, 5

• 72% of patients report no complaints referable to cervical disease and can carry out activities of daily living without impairment at final follow-up 3
• Motor function recovery occurs in 95% of patients within the first year, with improvements maintained over 12 months 1, 6
• Sensory function recovery occurs in 85% of patients within 1 year 6
• Mean Neck Disability Index (NDI) scores improve to 3.2 (on a 0-50 scale) postoperatively 3

Physical Therapy and Rehabilitation

Both early cervical spine stabilizer training and usual care result in equivalent improvements at 6 and 12 weeks post-surgery, so either approach is acceptable. 7

• All patients show significant improvements in pain levels, disability scores, and neck muscle strength/endurance at 6 and 12 weeks regardless of specific therapy approach 7
• Physical therapy should address craniocervical flexor strength and endurance, which can be reliably measured after ACDF 7

Follow-Up Schedule and Monitoring

You require radiographic evaluation with plain films in the early post-operative period to assess hardware position and alignment. 1

• At 3 months: Radiographic assessment evaluates fusion progress, cervical alignment, and monitors for pseudarthrosis or adjacent segment degeneration 1
• At 1 year: Radiographic assessment confirms solid fusion, which occurs in 87-96% of cases by 12 months 1
• CT is the most sensitive modality to assess fusion status if you have persistent symptoms, altering treatment plans in 39-60% of symptomatic patients 4
• MRI is most sensitive for soft-tissue abnormalities but may be limited by metal artifact from hardware 4

Expected Outcomes and Success Rates

You can expect good to excellent outcomes in approximately 90% of properly selected ACDF patients. 4

• 90.9% of appropriately selected patients experience functional improvement 1
• Fusion rates with anterior plating are 94% overall, compared to 88% without plating 4
• For two-level procedures, plating improves fusion rates from 72% to 91% 4
• Significant improvements occur in physical function, social function, physical role function, fatigue, and bodily pain 1, 4

Warning Signs Requiring Immediate Attention

Do not attribute new neurological symptoms to simple post-operative pain without thorough investigation. 1

• New or worsening arm/hand weakness requires urgent evaluation 1
• New numbness or tingling in a different distribution than pre-operative symptoms warrants assessment 1
• Difficulty swallowing, breathing problems, or significant neck swelling require immediate medical attention 2
• Unilateral pupillary abnormalities require urgent neuroimaging 1

Long-Term Considerations

You should be monitored for adjacent segment disease and late hardware complications during long-term follow-up. 1, 4

• 30% of patients develop new sensory deficits at final follow-up, with 60% occurring at adjacent levels 6
• 14% develop new motor deficits by final follow-up, with 76% occurring at adjacent levels 6
• Patients with preoperative sensory deficits are more likely to develop new deficits postoperatively 6
• Adjacent segment degeneration is a potential long-term complication requiring monitoring 4

Special Risk Factors

If you smoke or are on Worker's Compensation, you may require more intensive monitoring, though outcomes can still be favorable. 1

• Smoking status should be documented as it may affect fusion rates with certain graft materials 5
• Age and smoking did not significantly affect outcomes in some studies 1

Pseudarthrosis Management

If fusion failure (pseudarthrosis) occurs, posterior revision approaches have higher success rates (94-100%) compared to anterior revision (45-88%). 4

• Radiographic pseudarthrosis occurs in approximately 4-7% of patients 3
• Some patients with pseudarthrosis remain asymptomatic, as fusion status does not always correlate with clinical outcomes 1