Anterior cervical discectomy and fusion (ACDF) is a surgical procedure to remove a degenerated or herniated disc in the neck. The doctor makes an incision in the throat to reach the front of the spine. The surgeon then removes the defective disc and insert a graft to fuse the bones above and below the site of the injury.
The doctor may or may not use a microscope to perform the surgery; there are some indications that doctors who do use the microscope have patients who tend to have less pain as the graft heals. The doctor may use the patient's own bone to make a graft or use a substitute material such as tricalcium phosphate/hydroxyapatite (TCP/HA) composite and iFactor placed within a polyetheretherketone (PEEK) cage. Most patients who get the synthetic materials have a good experience with them. Patients who get a competing procedure called cervical artificial disc replacement (C-ADR) tend to recover faster than people who get ACDF, but ACDF and C-ADR have equally good long-term outcomes.
Pain medications are usually classified as strong (oxycodone, morphine, or meperidine) or weak (codeine, propoxyphene, or hydrocodone). People who have been on a strong pain relief program before surgery usually have slightly less favorable results from the graft than people who have been on a weak pain relief program before the surgery.
All of this information, however, really relates to what your doctor decides for you. What can you do to make your recovery from ACDF surgery easier?
- Follow all the restrictions your doctor orders. You absolutely, positively do not want to do too much too soon.
- Listen to your body. Stop before it tells you it is hurting.
- Ask to try on a collar before surgery. You will probably wake up in a collar and it's better not to be surprised. You get used to the collar quickly, sometimes in just a day or two.
- Ask about trancutaneous electrical nerve stimulation (TENS) for pain relief. There are devices that you can buy over the counter without a doctor's prescription but you may be able to get your doctor to recommend something that works better than you can find on your own.
- Stock up on pet food before surgery. Most bags of pet food are far over the 8-pound (4-kilogram) limit doctors usually recommend. If you forget, get a friend to get this from the store for you and to take it into your home.
- Make sure you have button-up or zip-up shirts or blouses to wear after the surgery. You may not be able to wear T-shirts or pullovers.
- Showers are OK for keeping incisions clean, but no baths, hot tubs, or swimming until the surgical site is completely healed.
- A condition called "lazy lung" (atalectasis) can make you more prone to fevers and respiratory infections as you recover from your surgery. Your doctor will probably give you a spirometer to practice deep breathing to keep your lungs open and infection free as you recover from ACDF.
- Cold packs can relieve throat pain. Don't place a frozen pack or ice directly on skin, however. You don't want frostbite to add to your list of post-surgical complications.
- If you can't sleep in bed with a wedge pillow, try a recliner. Some people can sleep in bed if they take a lot of pillows and make a U and then put themselves in the middle.
- Don't skip physical therapy. Usually physical therapy focuses on building up the small muscles that stabilize the spine. You need to have these smaller muscles in good condition before you can start lifting with larger muscles again. This is especially true for anyone who has done strength training and wants to return to it after ACDF surgery.
- Muscle memory can lead you to attempt tasks seem easy until you find out that inactivity has left your muscle in bad condition. Don't attempt any physical activity on "autopilot" until you are fully recovered.
- Severe pain, numbness or tingling, inability to urinate, paralyzed bowel movement, increased swelling of the ankles or feet, and increased weakness in the arms and legs are signs you need to see a doctor right away. If you can't see your orthopedist the same day, ask about which emergency room can best meet your needs and get there.
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