Anterior cervical discectomy and fusion (ACDF): an OR 101 guide

Reviewed by Rodnie Oro, cath lab charge nurse · Last reviewed: October 2026 · Education only, not medical advice

ACDF in one minute

What it is: surgery through the front of the neck to remove a disc pressing on a nerve or the spinal cord, then fuse the level with a spacer (cage).

Who it is for: people with arm pain, weakness or spinal cord problems from a neck disc or bone spurs.

Main risks: swallowing difficulty, hoarse voice, bleeding (urgent if in the neck), nerve or spinal cord injury (rare), fusion not healing.

Usually: under general anaesthetic, 1–3 hours, 1–2 nights in hospital.

On this page: What is ACDF? · Who is it for? · When is it done? · Step by step · Recovery · Risks · Kit list · First time in theatre? · FAQ

What is ACDF?

The cervical spine is the neck part of the spine. A worn or bulging disc, or bone spurs, can press on a nerve root (arm pain, numbness, weakness) or the spinal cord.

In an ACDF the surgeon:

• makes a cut in the front of the neck and gently moves the windpipe and gullet aside
• removes the disc and anything pressing on the nerve, usually with a microscope
• places a spacer (cage) in the disc space, often with a small plate and screws
• checks the level with X-ray

Over months, bone grows across the level (fusion). Disc replacement is an alternative for some.

New to the acronyms? See the Cath Lab Abbreviations A–Z.

Who is it for?

It may be considered for people with:

• arm pain or weakness from a trapped nerve not helped by other treatment
• spinal cord compression (myelopathy)

The decision is made by your spinal team, who will talk through the reasons, the alternatives and the risks with you.

When is it done?

Most operations are planned; some are urgent. Before it, you usually have:

• an MRI scan and sometimes X-rays or CT
• blood tests and an ECG
• a review of medicines, as per centre protocol
• a chance to ask questions and give consent

Step by step

1. Getting ready

Team brief and WHO checklist first, including the site and side marking. The anaesthetic team and ODP give the anaesthetic (general, as per centre protocol); antibiotics and blood-clot prevention are given as per centre protocol. The circulating practitioner checks positioning, pressure areas, the diathermy plate and warming. The scrub practitioner sets up the instrument trolley and does the first count. The implant check and level check plan are confirmed; the neck is positioned gently and the X-ray set up with radiation protection.

2. Access

A short cut in a skin crease on the front of the neck, usually on one side.

3. Removing the disc

• A. Disc found. The level is confirmed with X-ray.
• B. Disc removed. The disc and spurs are removed under the microscope.
• C. Spacer. A spacer (cage) is placed in the disc space.
• D. Plate. A small plate may be fixed; X-ray checks the position.

The level is checked on X-ray before the disc is removed; the team calls out every screening.

4. Finishing

Bleeding is controlled, a drain may be placed, per surgeon, and the neck closed. Final counts are confirmed, implants recorded, and the patient goes to recovery with airway and neck swelling checks.

Recovery and aftercare

• First hours: checks of breathing, swallowing and neck swelling.
• Going home: often 1–2 days.
• Swallowing: a sore throat and mild swallowing difficulty are common for a few weeks.
• Neck: a collar is not always needed; follow advice.
• Work and driving: as advised by your team.
• Follow-up: clinic and X-rays.

Call 999 if you have a seizure, sudden severe headache, confusion, drowsiness, weakness or collapse. Contact your team if you have a fever, leaking wound, worsening headache or vomiting.

Risks and complications

Your team will explain the risks that apply to you. Possible problems include:

• swallowing difficulty or hoarse voice, usually temporary
• bleeding or swelling in the neck that affects breathing (urgent)
• nerve or spinal cord injury (rare)
• leak of spinal fluid (rare)
• fusion not healing
• problems at the next level over time

Theatre kit list (printable)

Example kit list

Every theatre has its own protocol, and sizes and doses vary.

• spinal instrument set with neck retractor
• operating microscope
• high-speed drill
• spacer (cage), size per device and operator
• plate and screws, per device and operator
• X-ray, radiation protection
• drain and closure sutures

Procedural steps

• Team brief, WHO sign in; implant check; anaesthesia
• Positioning; X-ray set up; prep and drape; count
• Neck cut; level checked on X-ray
• Disc removed under microscope
• Spacer and plate; X-ray check
• Closure; counts; implant log; sign out and handover with airway checks

First time in theatre?

💡 First-time tip

• Know your role. Scrub, circulating, anaesthetic and ODP each have their own checks; ask at the team brief.
• Counts matter. Swabs, needles and instruments are counted before, during and at closure; speak up if one is missing.
• Microscope. Drape the operating microscope sterile and balance it before the case.
• Implant check. Read back implant types and sizes before opening and record them.
• Radiation. Wear lead and step back when X-ray is used.

FAQ

Will my neck move normally?

Most people lose very little movement after one level.

Will I need a collar?

Often not; your team will advise.

How soon will my arm pain improve?

Arm pain often improves quickly; numbness can take longer.

Related guides

• Spinal fusion
• Craniotomy
• Cath Lab Abbreviations A–Z

Sources

All checked on 14 October 2026. Each page's own date is shown where it gives one.

• NHS. Cervical spondylosis. nhs.uk/conditions/cervical-spondylosis
• NHS. Slipped disc. nhs.uk/conditions/slipped-disc
• StatPearls (NCBI Bookshelf), search: anterior cervical discectomy and fusion. ncbi.nlm.nih.gov/books
• Society of British Neurological Surgeons. www.sbns.org.uk
• World Health Organization. Surgical Safety Checklist. who.int

Disclaimer

Education only. This page is for general education for healthcare students, theatre staff and curious readers. It isn't medical advice and doesn't replace advice from your own doctor, surgical team or local unit protocols. Equipment and medicines are described generically. No product or manufacturer is recommended. If you think someone is having a medical emergency, call 999.

Disclosure: I work in the medical device industry. This page is independent education and isn't sponsored or reviewed by any company.

All diagrams on this page are original illustrations created for rodnieoro.com.