The ACDF is performed with the patient in a laying on his or her back. An intraoperative x-ray machine is used throughout the procedure to confirm that the correct vertebra/vertebrae are being operated on. After locating the proper vertebra, the skin is marked, cleaned, and draped for sterility. A small incision, less than one inch, is made and the muscles on the front of the neck are gently parted. While working to part through the muscles, the vessels of the neck, including the carotid artery and jugular veins are carefully moved out of the surgical field.

Once the spine is exposed specialized retractors keep the incision open for the duration of the procedure, allowing the surgeon to see and operate. The anterior longitudinal ligament, a large ligament that runs along the spinal vertebrae, is removed to reveal the disc space between the affected vertebrae. The intervertebral disc is removed from this space via a series of biting instruments, until nothing occupies the disc space. After the disc is removed, the spinal cord and nerve roots are visible; compressing disc herniations or bone spurs can be removed to relieve pressure on the nerves and/or spinal cord.

To prepare the disc space for the implant and the fusion hardware, the disc space is drilled to provide a smoother surface and then measured to select an implant that will fit in the space. Once the correct size implant has been chosen, it is filled with bone graft either from the patient or a cadaver, and placed into the empty disc space to create a fusion; the implant is secured into the bone using screws in order to prevent further motion at the spinal level. The implant fit and spinal alignment are confirmed with intraoperative imaging. After placing the hardware, the retractors are removed from the incision and bleeding is controlled. Each layer of tissue is closed with sutures and the final layer of skin is usually closed with a special medical grade glue, which typically leaves less scaring after healing; the final layer may be fully closed with sutures depending on the surgeon’s preference and on the patient’s skin.

After surgery the patient recovers in a post-operative room to make sure that their pain is under control, that they are able to eat and tolerate food and beverage, and that they can walk and urinate properly. They are able to go home within 23 hours of the procedure, but a friend or family member should be available to drive the patient home and to monitor the patient for at least 24 hours after the procedure.