ACDF Surgery

Everything You Should Know About Cervical ACDF Surgery

What is ACDF surgery? Anterior Cervical Discectomy and Fusion surgery is performed to remove a degenerative or herniated disc in the neck of the patient. As with other forms of spinal surgery ACDF surgery is only recommended as a last resort if all other reasonable efforts to obtain relief by way of more conservative methods have failed. With this type of surgery the corrupted disc in the neck is removed and a spinal interbody fusion cage (titanium implant) inserted in order to fuse the bones above and below the site of the removed disc together.

NHS Funding for ACDF

There’s no type of spinal surgery that can be considered “affordable” in the UK. Fortunately, the NHS will often compensate UK citizens who have this type of surgery performed abroad in places like Riga, where the cost is as much as 60% lower than in London or Dublin and waiting lines are practically non-existent. There are 2 NHS funding routes for this type of surgery abroad: the EU Directive route and the S2 route.

• The EU Directive Route – This funding route is named after an EU directive that allows legal residents of any EU country to seek medical services in other EU countries and be reimbursed for them. While no type of cosmetic surgery is covered by this directive many other types of important, quality of life procedures are. With the EU Directive route you will need to pay the cost of the surgery up front and then apply for reimbursement when you return home.
• The S2 Route – The S2 route does not require any out of pocket payments by the patient. Instead S2 covers the entire cost of the procedure for you. The catch is that you are limited to using state sector medical providers only. Whereas with the EU Directive route you can choose either a state sector or private sector healthcare provider.

There are many who prefer the S2 route because it won’t cost them anything out of pocket. However this type of funding is typically harder to obtain and besides, many others prefer the wider variety of providers they’re able to choose from with the EU Directive route.

Indications for ACDF Surgery

This type of surgery is typically helpful in treating a bulging or herniated disc in the neck or a disc that has been ravaged by degenerative disc disease. But not everyone with these conditions will be a good candidate. To be considered a good candidate a patient should have:

• Conclusive diagnostic (MRI) evidence of cervical disc herniation or degenerative disc.
• Pain that extends down the arm (brachialgia) in addition to significant pain in the neck area.
• Arm pain worse than neck pain.
• Significant weakness  in the arm and/or the hand
• Tingling, numbness or “pins-and-needles” sensations in the hands or arms.
• Tried more conservative treatments without any improvement in their condition.

The degree to which a patient suffers these symptoms will go a long way toward determining whether or not surgery is indicated. If the nerve root seems only minimally compressed the surgeon may advise against the procedure.

Contraindications

The most obvious contradiction – and the one that is most often cited when it comes to ACDF spine surgery – is not giving more conservative treatments adequate time to provide the necessary relief. While it’s understood that a herniated or degenerative disc in the neck can produce some very odious symptoms that make people impatient for relief, it is nonetheless important to give the less extreme treatments enough time to work. So if the surgeon believes a patient has not given conservative treatments their due he will likely recommend against the procedure.

Beyond that other contraindications include an active infection or a known allergy to any of the materials used during the procedure.

Pre-operative Exam and Lead up to Surgery

Should you decide to save time and money by having your spinal procedure at Neuro Spine Riga you will be asked to undergo a pre-operative assessment in the days before surgery. The assessment consists of a physical exam as well as blood tests. The goal is to ensure you are physically fit enough to endure both the anaesthesia and the surgery itself. There is also an MRI to confirm the diagnosis. You will meet your surgeon during this pre-operative assessment and will have a chance to air any lingering questions or concerns you might have.

In the lead-up to surgery you’ll be advised to stop taking NSAIDs such as Advil, Motrin, Nuprin etc as well as aspirin or other medications that might promote bleeding. It’s also suggested that you refrain from drinking alcohol in the week leading up to surgery and that you stop smoking or using other tobacco products as well. 6 to 12 hours before the operation all food and beverage intake will cease.

The day of the operation you will:

• Shower using an antibacterial soap and put on clothes that have been freshly washed.
• Make sure you are not wearing makeup and that all jewellery, hairpins, body piercings and the like have been removed.
• Be fully prepared to undergo surgery 2 hours prior to the scheduled start time.
• Meet with the anaesthesiologist to discuss the effects and risks of the anaesthesia that will be used.

The Surgery Itself

Typically anterior cervical decompression surgery will take anywhere from 1 to 3 hours depending on the patient and their particular physiology. The surgery itself, while exacting, typically proceeds through the following steps.

• Anaesthesia – The patient will lie on their back on the operating table and be administered a general anaesthesia. Once asleep the operative site will be cleaned and prepped.
• Incision – A 2 inch incision is then made in either the right or left side of the neck. Accessing the neck through this incision the surgeon creates a tunnel through which he will operate. This is done by moving muscles to the side and retracting the trachea, blood vessels and esophagus.
• Locating the disc – The surgeon uses a fluoroscope to help locate the affected vertebrae and disc. Once the area to be operated on is located a retractor is inserted and the bony vertebrae above and below the damaged disc are separated.
• Removing the affected disc – Surgery is performed under an operating microscope using microsurgical instruments. The affected disc is removed in stages starting at the front and moving toward the back. The ligament behind the vertebrae is moved to allow access to the spinal canal and any disc material found to be pressing on the nerve is excised.
• Cervical decompression – Any bones spurs that were causing pressure on the nerve are also removed. More space is created for the nerve to occupy using a process called foraminotomy.
• Cervical cage fusion – After the disc is removed, the space between the bony vertebrae is empty. To prevent the vertebrae from collapsing and rubbing together, a special titanium implant is inserted to fill the open disk space and to create a spinal fusion.
• A support plate is installed – In some cases the new implant is buttressed with a metal plate that is screwed into the vertebrae above and below the former disc site. This plate ensures the spine in this area is stable during the fusion process.
• The incision is closed – After the support plate is installed (if one is deemed necessary) the spreaders are withdrawn, the muscles and other materials are returned to their original position and the incision is closed; typically with sutures or steri-strips.

Risks and Potential ACDF Complications

Every type of surgery carries with it some potential risks and the possibility of complications. Certainly the ACDF procedure is no different. Risks and complications are generally broken down into 2 categories: Short term risks/complications and long term risks/complications.

Short Term Risks and Complications

• Wound infection and discitis – This type of surgery typically has a low incidence of postoperative infections (around 0.1%). When an infection does occur it usually manifests itself as pain and perhaps drainage from the wound. The patient may experience pain while swallowing as well as chills, fever, night sweats and respiratory problems. In general however such infections respond well to antibiotics.
• Dural tear – Dural tears are another potential complication of this surgery and happen in around 0.3% of patients. The dura is filled with cerebrospinal fluid (CSF). If a tear in the dura occurs during surgery CSF leakage can result in headaches, nausea, dizziness, photophobia, vertigo, vomiting and more. Rest assured however that your Neuro Spine Riga surgeon is fully capable of dealing with the situation in a timely and effective manner.
• Difficulty swallowing – The cervical spine is behind the esophagus which must be retracted during surgery. On rare occasions retracting the esophagus during surgery can lead to difficulty swallowing in the hours and days after surgery. In addition if a stabilization plate was installed to aid in fusion it may also interfere with swallowing. If a multi-level fusion was performed it may result in a more severe level of swallowing difficulty.

Long Term ACDF Risks and Complications

• Failure to fuse – While it is not common it is possible that the bony vertebrae of the spine will not fuse in the days and weeks following surgery. There are many possible causes for this failure to fuse including osteoporosis, malnutrition, obesity and more. Again though, failure to fuse is exceedingly rare.
• Bone graft shift – Another rare but possible side effect is migration of the bone graft from its correct position between the vertebrae. This typically occurs in about 1.5% of patients. This is known to be a more likely occurrence if no stabilization plate is installed or in cases when fusion is being attempted between multiple vertebrae. In cases of bone graft shifting the surgeon may recommend corrective surgery.
• Nerve or spinal cord damage – Any time surgery is performed on or around the spinal cord there is a risk of nerve damage. In such cases the patient may experience numbness, pins and needles, weakness in the extremities or even paralysis. In some cases however any pain may not be the result of surgery but legacy pain left over from the herniated disc.

After Surgery

Immediately after anterior cervical discectomy and fusion surgery patients are moved to the recovery room where their heart rate, blood pressure and respiration are all monitored. If there is pain upon awakening it will be addressed promptly. Once awake the patient will be moved to their regular room. In most cases after a few hours of recovery patients are allowed to go home the same day.

Once discharged the patient may be prescribed OTC painkillers like acetaminophen. Should the patient suffer hoarseness and a sore throat after surgery they should not be alarmed as this is a normal side effect of the procedure.

Post-Surgical Restrictions

It is recommended that you avoid NSAIDS such as Motrin, Advil and Nuprin for up to 6 months following surgery. NSAIDs can potentially encourage bleeding and interfere with the healing process of the bones. In addition:

• It is recommended that you do not engage in any type of heavy lifting until cleared to do so by your medical support team and that you not consider driving for at least 2 to 4 weeks.
• Avoid yard work or even basic housework until cleared by your physician to do so. So no mowing, pruning, raking, ironing or vacuuming and no loading the washer and dryer either.
• It is possible you will need help conducting daily activities such as bathing or even dressing for the first week or so after surgery.
• No tubs, swimming pools or hot tubs in the days immediately following surgery. It is best if you wait for your medical support staff to give you the okay.
• Any staples or stitches will remain in until the surgeon decides they can be safely removed. Typically that is no more than a few days.
• Discuss with your surgeon the proper way to treat the incision in the days immediately after surgery. You may be advised to avoid showers in addition to tubs and the like.

Call Your Surgeon if…

You develop a temperature that exceeds 101 degrees Fahrenheit or you develop other signs of an infection. Also, if you experience problems swallowing or breathing it’s time to call your surgeon as well.

Cost Comparison Chart

If you wish to have your spinal surgery at Neuro Spine Riga you can schedule an appointment now, have your surgery in the next couple of weeks and pay a fraction of what you’d have to pay in the UK. Below is a comparison of costs for this type of procedure in various European cities:

As the chart indicates the cost of having your surgery at Neuro Spine Riga is significantly less than it would cost you to have the same surgery in London, Dublin or most other European cities. Therefore, even if NHS declines your request for reimbursement it is likely you will be able to afford the procedure yourself. Our friendly and experienced staff can give you numerous tips on how to do so.

Note: The above prices represent an average of what this type of surgery would cost as of this writing at private clinics and hospitals in the above cities (with the exception of Neuro Spine Riga). The exact price at a particular clinic is likely to vary from the average noted above.

ACDF Recovery

Recovery from ACDF surgery typically takes 4 to 8 weeks, although other factors such as the patient’s overall health could cause the recovery period to be somewhat longer. It is crucial that you not try and force matters during your ACDF surgery recovery by rushing back to work, exercising beyond what the physiotherapist has recommended or engaging in strenuous activities around the house.

In some instances patients will experience recurrent neck pain in the aftermath of surgery. In and of itself this is nothing to be alarmed about and there are some simple things you can do to minimize any discomfort and prevent future recurrences:

•        Practice proper lifting techniques (ask your physiotherapist).
•        Always maintain good posture while sitting, standing, walking or sleeping.
•        Have your work area arranged in a way that is ergonomically efficient.
•        Maintain a lean body and appropriate BMI.
•        Learn stress management techniques and try to maintain a positive attitude.
•        Avoid excessive alcohol intake.

Why So Many People Choose to Have Their Surgery in Riga

There are a number of reasons why people decide to have their ACDF operation in the Latvian capital of Riga. Here are just a few:

• Our highly trained staff – One thing that will jump out at you straight away when you arrive at Neuro Spine Riga is the quality of the support staff. Each member of our team was chosen for their expertise, their easy-going manner and their ability to speak English. You’ll never feel like a stranger in a strange land at Neuro Spine Riga.
• State of the Art operating facilities – Every surgical theatre at Neuro Spine Riga is outfitted with the most up to date, leading edge equipment. We are committed to constantly upgrading every aspect of our facility for the continued benefit of our patients. Our outstanding ACDF surgery success rate is a testament to the quality of care we provide.
• No waiting – It’s not unusual to have to wait months (and in some cases more than a year) to have your surgery on the NHS in the UK. Even places like Dublin can have formidable waiting lines. When you’re in pain and the quality of your life is suffering there’s nothing worse than waiting for your number to be called. That won’t happen at Neuro Spine Riga. You can have your cervical decompression surgery just weeks after first contacting our UK patient coordinator.
• Convenience – Riga is less than 2 1/2 hours by air from London. There are no insufferable 14 hour flights, no endless layovers in foreign airports to endure. You get out of your own bed in the morning and are talking face to face to our support staff at Neuro Spine Riga in the afternoon. The day of your surgery you will spend a few hours recovering and then most patients will be able to fly home that same evening.

Conclusion

Neuro Spine Riga is one of Northern Europe’s most respected surgical facilities for ACDF surgery with a well-earned reputation for excellence and affordability. There is no drop off in the quality of your care from London or Dublin to Riga and the fact that there are no wait lines means you can soon bring an end to your pain and discomfort.