ACDF (Anterior Cervical Discectomy and Fusion)
Fusion surgery to relieve neck pain and arm symptoms from cervical disc disease
Anterior Cervical Discectomy and Fusion (ACDF) is the most commonly performed cervical spine surgery. It is performed through a small incision at the front of the neck to remove a damaged disc — including any herniated fragments or bone spurs pressing on a nerve or the spinal cord. The space between the vertebrae is then filled with a bone graft or implant, and the vertebrae are fused together with a metal plate and screws. ACDF reliably relieves arm and hand pain (radiculopathy) and can halt the progression of spinal cord dysfunction (myelopathy).
Who Is a Candidate?
- Cervical disc herniation causing arm or hand pain (radiculopathy) not improving with 6–12 weeks of conservative care
- Cervical myelopathy — spinal cord compression causing weakness, coordination problems, or difficulty walking
- Cervical stenosis from bone spurs or disc degeneration causing significant nerve or cord compression
- Cervical radiculopathy with progressive neurological weakness
- Failure of physical therapy, cervical injections, and pain management
What to Expect
1Before Surgery
An MRI confirms disc herniation or stenosis and correlates with your symptoms. A neurological exam documents baseline strength and reflexes. Pre-operative testing depends on your age and health. ACDF is usually done under general anesthesia as either outpatient or with a single overnight stay. You may need to stop blood thinners and anti-inflammatory medications beforehand.
2The Procedure
The surgeon makes a 1-inch incision on one side of the neck. The trachea and esophagus are gently moved aside to expose the front of the cervical spine. The affected disc is removed along with any bone spurs. A bone graft or synthetic spacer is inserted to restore disc height and maintain the alignment of the spine. A small titanium plate and screws are attached to the front of the vertebrae to hold everything in place while the bones fuse. The procedure typically takes 1–3 hours depending on how many levels are treated.
3Recovery
Most single-level ACDF patients go home the same day or after one night. You can resume light activity within 1–2 weeks. Driving is typically restricted for 2–4 weeks. Return to desk work occurs in 2–4 weeks; physical labor in 6–12 weeks. A soft cervical collar may be worn for 2–4 weeks. Fusion is confirmed by X-ray at 3–6 months post-op. Physical therapy begins at 4–6 weeks.
Typical Outcomes
ACDF is highly effective — approximately 90% of patients experience relief of arm and hand pain (radiculopathy) after surgery. Neck pain improvement is somewhat less predictable. For myelopathy, the goal is to halt progression and allow some neurological recovery; improvement depends on the severity of cord compression before surgery. Fusion rates are 95–100% for single-level procedures.
Risks & Considerations
- Difficulty swallowing (dysphagia) — most commonly temporary, lasting days to weeks
- Hoarseness from retraction near the recurrent laryngeal nerve (usually temporary)
- Non-fusion (pseudarthrosis) — more common with multilevel procedures or smoking
- Adjacent segment disease — degeneration at levels above or below the fusion over time
- Hardware failure (rare) — plate or screw loosening
- Infection (1%)
- Nerve or spinal cord injury (rare)
Frequently Asked Questions
Can ACDF be done without fusion — just a disc removal?
In some patients, especially younger adults with good disc height, cervical disc replacement (arthroplasty) is an alternative to ACDF that preserves motion at the treated level. Studies show similar outcomes to ACDF for radiculopathy with potentially lower rates of adjacent segment disease. Ask your surgeon if you are a candidate.
How many levels can be treated with ACDF?
ACDF can treat one, two, three, or rarely four levels. Single-level (1-level) ACDF is the most common. The complexity, recovery time, and risk of non-fusion increase with each additional level treated.
How long does the fusion take?
Bone fusion is a biological process that takes 3–6 months to confirm on X-ray. You will typically have a follow-up X-ray at 6 weeks, 3 months, and 6 months to monitor fusion progress. Until solid fusion is confirmed, heavy lifting and contact sports are restricted.
Will I lose range of motion in my neck?
Each fused level reduces total neck range of motion by approximately 10–15%. Most patients adapt well, especially if the degenerated disc was already limiting movement before surgery. Turning limitations are most noticeable for single-level fusions at C5-C6 or C6-C7. Multilevel fusions cause more noticeable restriction.
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Medical disclaimer: This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with any questions you may have regarding a medical condition or surgical procedure. Last reviewed March 2026. CPT: 22551.