Alternatives To ACDF Surgery

Do you have neck pain and have been told you need surgery? Does the thought of surgery terrify you? Have you been told all the different treatment options for your neck condition? Are you looking for alternatives to surgery? Read on to learn about the benefits and risks of ACDF surgery and alternative treatments.

What Is ACDF Surgery?

ACDF stands for “anterior cervical discectomy and fusion.” It is a surgical procedure performed on the neck to relieve pressure on the spinal cord or nerve roots caused by a damaged or degenerated disc. During the procedure, the surgeon removes the damaged disc and replaces it with a bone graft or synthetic implant. Metal plates and screws may be used to hold the vertebrae together during the fusion process.

ACDF surgery can help relieve symptoms such as neck pain, numbness, tingling, and weakness in the arms or hands caused by nerve compression in the neck. It is a commonly performed procedure and can help, but, as with any surgery, there are potential risks and complications that can occur.

When Do Physicians Typically Recommend ACDF?

ACDF may be recommended for cervical herniated discs, spinal stenosis, spondylolisthesis, and radiculopathy if all other more conservative measures have failed. It should only be recommended as a last treatment option unless there is an urgent surgical indication. If you have direct nerve or spinal cord compression or nerve injury is suspected, ACDF may be recommended without trying conservative measures first.

Cervical Facet Syndrome

Cervical facet syndrome, also known as cervical facet joint pain, is a condition that occurs when the facet joints in the cervical spine become inflamed or damaged. The facet joints are small joints located between the neck vertebrae, which help to provide stability and facilitate movement. When these joints become irritated or injured, they can cause pain and discomfort in the neck and surrounding areas. Symptoms of cervical facet syndrome can include neck pain, stiffness, headaches, and even radiating pain into the shoulders, arms, and upper back. Treatment options for cervical facet syndrome may include physical therapy, medications, injections, or in some cases, surgery.

Read More About Cervical Facet Syndrome

Cervical Radiculopathy

Common Cervical Radiculopathy symptoms include neck pain, arm pain, shoulder pain radiating down arm to fingers, numbness, tingling, and weakness. Cervical Radiculopathy is a clinical condition in which a nerve or nerves in your neck become irritated or compressed. It is also known as ” a pinched nerve,” The causes are discussed below. It can affect individuals of any age with peak prominence between ages 40-50 years of age. Cervical Radiculopathy is due to spinal nerve inflammation, irritation, or compression. The most common causes of Cervical Radiculopathy are: Disc Injury – The disc is an important shock absorber. Unfortunately, it is susceptible to injury.

Read More About Cervical Radiculopathy

Herniated Cervical Disc

Cervical discs, also known as intervertebral discs of the cervical spine, are the specialized structures located between the vertebrae in the neck region. These discs play a crucial role in providing cushioning, flexibility, and support to the cervical spine. Structure: Cervical discs have a unique structure consisting of two main components: Nucleus Pulposus: The nucleus pulposus is the central, gel-like core of the disc. It is composed of a jelly-like substance with a high water content, giving it a soft and elastic nature. The nucleus pulposus is responsible for absorbing and distributing forces acting on…

Read More About Herniated Cervical Disc

Pinched Nerves in the Back

We talk a lot about leg pain stemming from a pinched or irritated nerve in the lower back. And, indeed, that’s what our physicians are traditionally taught in medical school—a pinched nerve in the lumbar spine typically presents as a symptom in the leg. However, what if you have some butt pain but no pain or other symptoms in the leg? Does this mean it couldn’t be a pinched nerve? Not so fast. Turns out a pinched low back nerve doesn’t always have to be accompanied by leg symptoms. Let’s start by taking a look at how the back is structured.

Read More About Pinched Nerves in the Back

Spinal Instability

Spinal instability is a condition that occurs when the spinal column is not able to maintain its normal alignment and function under normal loads. It can be caused by various factors such as trauma, degenerative changes, infections, tumors, or congenital abnormalities. In a stable spine, the bones, discs, ligaments, and muscles work together to support and protect the spinal cord and nerve roots. However, in an unstable spine, the structures that support the spine may be damaged or weakened. This can lead to abnormal movement and excessive stress on the spinal cord and nerves. In most cases, bone and joint problems…

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Spinal Stenosis

Spinal stenosis is the narrowing of the central spinal canal and is a cause of significant pain and disability.  Common causes of spinal stenosis include disc protrusion, facet overgrowth and ligamentum flavum thickening.  Surgery is often chosen when conservative therapies fail despite the lack of convincing evidence that it is a superior treatment option.  Are there alternatives to back surgery for spinal stenosis?  Yes. Regenexx DDD utilizes precise platelet injections into the facets, muscles, and ligaments to treat the lumbar stenosis, treating all of the components of the issue, which is crucial. Spinal stenosis is often an age-related condition attributed…

Read More About Spinal Stenosis

Spondylolisthesis

Spondylolisthesis means that one vertebra is slipping forward or backwards on another. This causes the hole where the nerve exits (foramen) to get smaller (also called foraminal stenosis). It also causes more wear and tear on the facet joint which can lead to arthritis or what’s called “facet hypertrophy”. spondylolisthesis recovery The amount of slippage is graded 1-4, with grade 1 meaning that the one vertebra has slipped up to 25% on the other vertebra. Grade 2 means that one bone has slipped from 25-50% with higher grades indicating more slippage. The vast majority of patients are grade 1 to 2.

Read More About Spondylolisthesis

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Factors To Consider Before Undergoing An ACDF Surgery

Success Rates

The success rates of ACDF surgery can vary depending on several factors, including the specific condition being treated, the extent of the surgery, and the individual patient. The success rates of ACDF surgery can range from approximately 80-90% for relieving neck pain caused by herniated discs or spinal stenosis to 90% for relieving arm pain (1-2). However, the success rates in smokers, those requiring multiple-level fusion, and older patients can have much lower success rates.

Potential Risks

As with any surgery, ACDF surgery carries certain risks and potential complications. Some possible risks and complications of ACDF surgery include:

• Infection: Infection of the skin or soft tissue can be a big deal and may need antibiotics or further surgery to clear out. 
• Bleeding: Bleeding can be self-resolving or cause compression around a nerve. 
• Nerve damage: Nerve damage can lead to weakness, numbness, or paralysis.
• Difficulty swallowing: Swallowing difficulties can occur due to inflammation, pain, or surgical trauma to the throat.
• Voice changes: Changes to the voice may occur if the recurrent laryngeal nerve, which controls the vocal cords, is damaged during the surgery.
• Graft rejection: The body may reject the bone graft used during the fusion process.

• Non-union or delayed union: The bone graft may not fuse properly with the adjacent vertebrae, leading to non-union or delayed union and requiring additional surgery.
• Hardware failure: The metal plates and screws used to hold the vertebrae together may become loose or break.
• Inadequate decompression: The surgery failed to alleviate the compression, and a revision may be required.
• Anesthesia complications: Rarely, anesthesia-related complications can occur, such as an allergic reaction, breathing problems, or heart complications.

Even when surgery is successful, there can be long term associated complications. With any fusion, there will be some stiffness and loss of full or normal range of motion. The most common long-term risk from surgery is adjacent segment disease (ASD). ASD is a complication that can occur after spinal fusion surgery, in which degeneration or other problems develop in the spinal segments immediately above or below the operated level due to increased stress and motion. Symptoms include pain, numbness, weakness, and reduced range of motion.

Benefits

The benefits of ACDF surgery would be alleviating pain and associated symptoms of nerve irritation. ACDF can improve physical function and quality of life in appropriate patients. If the spinal cord or nerves were compressed, ACDF can alleviate this compression and restore nerve function and prevent further nerve injury.

Recovery Time 

Recovery from ACDF surgery can vary depending on the individual patient, the extent of the surgery, and the specific condition being treated. However, in general, most patients will spend one to two nights in the hospital for monitoring and pain management.  Patients should expect significant post-procedure pain for a few days to weeks.

Some patients may require a brace for a short period of time. Most patients can return to normal activities within a few weeks to a few months following the surgery, depending on the extent of the surgery and the individual’s overall health. Full recovery usually takes 6-12 months. Patients must avoid strenuous activity and heavy lifting for several weeks after the surgery. Physical therapy will be recommended after surgery to aid recovery, mobility, strengthening, and improved function.

Is There Really An Alternative To ACDF Surgery?

There are several non-surgical alternatives to ACDF surgery. Let’s go over a few:

Physical Therapy

Physical therapy (PT) is usually the first-line therapy for most musculoskeletal problems. The goals of PT are to work on proper posture and alignment, neck curve restoration, cervical multifidus, deep neck flexor activation, upper back strengthening, loosening tight muscles, and improving range of motion.

Pros:

• safe
• can help many patients avoid surgery
• addresses underlying biomechanics
• can prevent further injury

Cons:

• can’t heal structural injuries to the disks, joints, or ligaments
• can be practitioner-dependent
• may not help enough

Non-Steroidal Anti-Inflammatory Drugs

NSAIDs are medications that can be taken over the counter or via prescription to help the pain by reducing inflammation. 

Pros:

• can help the pain
• may allow for PT or exercise therapy, or daily functioning

Cons:

• can Inhibit bone healing
• can inhibit tendon cells
• increases the risks of heart attack and stroke, kidney injury, GI bleeds, and ulcers
• increases the risks of chronic pain
• decreases testosterone (4-17).

Regenerative Options

More recently (over the last 15 years), many treatment options stimulate the body to heal itself. These treatments involve the injection of orthobiologics, or growth factors derived from your own body, precisely into damaged tissue to stimulate repair. Several studies show that regenerative treatments can help cervical issues (18-26).

Pros:

• can repair damaged tissue
• can address the root cause of problems
• safe
• mounting research shows efficacy

Cons:

• success is highly dependent on the skill and training of the practitioner
• not standard across doctors
• not covered by most insurance
• takes some time to be effective.

Platelet-Rich Plasma

Platelet-rich plasma (PRP): A concentrated solution of platelets and other growth factors extracted from a patient’s own blood, which is used to promote the healing of soft tissue injuries.

Pros:

• safe
• autologous (comes from and goes back into the same patient, so no risks of rejection)
• increasing evidence of efficacy for mild to moderate arthritis, joint problems, ligament, tendon, and disk injuries
• actually stimulates healing
• short recovery times
• can prevent the need for surgery

Cons:

• takes several weeks to months for full effects
• can cause soreness for a few days
• ACDF surgery can help relieve symptoms such as neck pain, numbness, tingling, and weakness in the arms or hands caused by nerve compression in the necknot covered by most insurance
• preparation and quality vary greatly between practitioners

Bone Marrow Aspirate Concentrate (BMAC)

Bone marrow concentrate (BMC) is a concentration of cells from the patient’s own bone marrow that contains live and functioning stem cells. BMAC is used to promote healing by injecting concentrated stem cells, other healing cells, and growth factors directly into an injured or damaged area.

Pros:

• safe
• autologous (comes from and goes back into the same patient so no risks of rejection)
• increasing evidence of efficacy for moderate to more severe injuries such as arthritis, joint problems, ligament, tendon, and disk injuries
• actually stimulates healing
• short recovery times
• can prevent the need for surgery

Cons:

• takes several weeks to months for full effects
• can cause soreness for a few days
• not covered by most insurance
• preparation and quality vary greatly between practitioners

Why An Expert Treatment Opinion Is Crucial To Your Recovery

Seeing a physician that is an expert in cervical spine problems preferable a non surgeon is crucial to figuring out what you problems are and treatment option. The general specialties that are trained to evaluate and treat spine problems are Physical medicine and Rehabilitation (PMR) with a Spine or pain fellowship, Anesthesiology with a pain or spine fellowship, orthopedics surgeons with spine training (only for surgical recommendations), neurosurgeon with spine training (for surgical recommendations.

These problems are not commonly diagnosed or treated well with the Emergency medicine doctor you may see after acute injury. Their role is to rule out life threatening problems only. Your family doctor, general practitioner, or internal medicine doctors does not have expertise in this area. Just having a doctor read an MRI report is also not sufficient.

Get The Best Treatment For Your Condition

ACDF surgery is a big deal. In the majority of people with neck and arm pain from cervical injuries, it should only be considered as a last resort. If there is direct nerve or spinal cord compression/injury then it is your only option and you should not delay. For all other cervical injuries you want to know all your options. The standard pain management can help some with symptoms but does not address the underlying issues.

Current regenerative treatments from a well-qualified expert provider can offer many patients hope and improve their pain, function and avoid surgery. At the Centeno-Schultz Clinic, we are all board certified fellowship trained musculoskeletal specialists with specific expertise in regenerative medicine and are the source of much of the world’s research in this area.

Looking for alternative treatment options for your condition? Schedule an appointment with us today!

More Resources

The Spine Owner’s Manual: How to Avoid Back Pain & Life-Altering Surgery

This e-book from Dr. Chris Centeno focuses on the spine and how it functions within the human musculoskeletal system and the body as a whole. Everything in our bodies works together like a well-tuned symphony to support our well-being, and a strong spine (including all of its component parts, such as spinal nerves, ligaments, muscles, etc.) is critical to complete health.

Using the Regenexx SANS approach, The Spine Owner’s Manual provides a series of tests and clearly defined exercises that you can do on your own to measure and monitor your own spinal health. These musculoskeletal tests will allow you to monitor where your own body might be struggling to maintain proper stability, articulation, symmetry, and neuromuscular function.

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References

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22. Lam KHS, Hung CY, Wu TJ. Ultrasound-Guided Cervical Intradiscal Injection with Platelet-Rich Plasma with Fluoroscopic Validation for the Treatment of Cervical Discogenic Pain: A Case Presentation and Technical Illustration. J Pain Res. 2020;13:2125-2129. Published 2020 Aug 20. doi:10.2147/JPR.S264033. Ultrasound-Guided Cervical Intradiscal Injection with Platelet-Rich Plasma with Fluoroscopic Validation for the Treatment of Cervical Discogenic Pain: A Case Presentation and Technical Illustration – PMC (nih.gov)Jull, GA. Deep Cervical Flexor Muscle Dysfunction in Whiplash. 2000, Vol. 8, No. 1-2 , Pages 143-154
23. Williams C, Jerome M, Fausel C, et al. (October 08, 2021) Regenerative Injection Treatments Utilizing Platelet Products and Prolotherapy for Cervical Spine Pain: A Functional Spinal Unit Approach. Cureus 13(10): e18608. doi:10.7759/cureus.18608
24. Centeno CJ, Elliott J, Elkins WL, Freeman M. Fluoroscopically guided cervical prolotherapy for instability with blinded pre and post radiographic reading. Pain Physician. 2005 Jan;8(1):67-72. PMID: 16850045.
25. Ashley Smith, Ben Andruski, George Deng, Robert Burnham, Cervical facet joint platelet-rich plasma in people with chronic whiplash-associated disorders: A prospective case series of short-term outcomes, Interventional Pain Medicine, Volume 1, Issue 2, 2022, 100078, ISSN 2772-5944. Cervical facet joint platelet-rich plasma in people with chronic whiplash-associated disorders: A prospective case series of short-term outcomes – ScienceDirect
26. Lam KHS, Hung CY, Wu TJ. Ultrasound-Guided Cervical Intradiscal Injection with Platelet-Rich Plasma with Fluoroscopic Validation for the Treatment of Cervical Discogenic Pain: A Case Presentation and Technical Illustration. J Pain Res. 2020;13:2125-2129. Published 2020 Aug 20. doi:10.2147/JPR.S264033. Ultrasound-Guided Cervical Intradiscal Injection with Platelet-Rich Plasma with Fluoroscopic Validation for the Treatment of Cervical Discogenic Pain: A Case Presentation and Technical Illustration – PMC (nih.gov)