ACDF Outcomes May Be Better With Earlier Surgery

Anterior cervical discectomy and fusion (ACDF) is popularly regarded as one of the most successful surgeries performed on the spine. You can learn a great deal about this procedure by watching this video from my partner, Dr. Seth Neubardt.

ACDF demonstrates not only a high success rate in improving preoperative symptoms but also has a very favorable safety/complication profile. Patients tend to tolerate the procedure well with relatively little postoperative pain and increased mobility when compared with some other commonly performed spinal operations. In an important article in a recent issue of Spine Journal, Dr. Burneikiene and associates asked and attempted to answer an important question: Is there an optimal timing to further perform surgery?

The findings of this study are instructive and important for Dr. Neubardt and myself as we routinely care for patients with this diagnosis.

That study suggests that patients who have surgery within six months of the symptom onset were associated with much better relief of their radicular, i.e. arm pain, but there was not a significant difference in the resolution or diminution in their neck pain. The criticism of this study is clear in that they did not distinguish between patients who had pure radicular, i.e. arm pain and those who had arm pain with neck pain or those who had neck pain alone.

Our suspicion is that those patients with true radicular symptoms will do best with earlier surgery, particularly if they develop evidence of weakness or loss of sensation or the pain is of such severity that it has limited their ability to function.

Jack Stern, M.D., Ph.D., F.A.C.S.