ACDF (Anterior Cervical Discectomy and Fusion)¶

Overview¶

ACDF is the most common cervical spine surgery. The disc is removed through an anterior approach, and an interbody graft (autograft, allograft, or cage) is placed between the vertebral bodies to achieve fusion. An anterior plate with screws provides additional stabilization.

Normal Post-Operative Appearance¶

Anterior plate spanning the operative level(s) with screws into adjacent vertebral bodies
Interbody graft or cage between the vertebral bodies at the disc space
Prevertebral soft tissue swelling — normal for 2–6 weeks after anterior approach
Endplate edema at the graft-bone interface (STIR hyperintensity) — normal during fusion

Imaging Evaluation¶

Radiography¶

Plate and screw position
Graft position and height
Alignment (lordosis maintained?)
Signs of complication: plate/screw migration, graft subsidence, graft extrusion

CT¶

Bony fusion assessment — bridging bone through or around the graft
Screw position and trajectory
Graft incorporation

MRI (with MARS)¶

Epidural space evaluation for residual compression
Cord signal (pre-existing myelopathy, new myelopathy)
Adjacent segment disc evaluation

Clinical Pearl

After ACDF, always evaluate the adjacent segments — the levels above and below the fusion are at increased risk for accelerated degeneration and new disc herniation (adjacent segment disease). This is the most common long-term complication of cervical fusion and the most common reason for reoperation.

Key Points¶

Most common cervical spine surgery — anterior approach
Prevertebral swelling is normal for 2–6 weeks post-op
CT is best for fusion and hardware assessment
Always evaluate adjacent segments for accelerated degeneration
Complications: graft subsidence, plate migration, pseudarthrosis, adjacent segment disease

References¶

Anterior cervical discectomy and fusion (ACDF). Radiopaedia.org. Available from: https://radiopaedia.org/articles/anterior-cervical-discectomy-and-fusion-acdf
Kani KK, Chew FS. Anterior cervical discectomy and fusion: review and update for radiologists. Skeletal Radiol. 2018;47(1):7-17. Available from: https://pubmed.ncbi.nlm.nih.gov/29058045/
Oshina M, Oshima Y, Tanaka S, Riew KD. Radiological Fusion Criteria of Postoperative Anterior Cervical Discectomy and Fusion: A Systematic Review. Global Spine J. 2018;8(7):739-750. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6232720/
Rai V, Sharma V, Kumar M, Thakur L. A systematic review of risk factors and adverse outcomes associated with anterior cervical discectomy and fusion surgery over the past decade. J Craniovertebr Junction Spine. 2024;15(2):141-152. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11216642/
Tsalimas G, Evangelopoulos DS, Benetos IS, Pneumaticos S. Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion. Cureus. 2022;14(7):e26888. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9375980/
Rhee JM, Ju KL. Anterior Cervical Discectomy and Fusion. JBJS Essent Surg Tech. 2016;6(4):e37. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6132613/