Anterior Cervical Discectomy and Fusion: A Two-Case Series and Literature Review on Management and Outcomes
-
Daniel Encarnación-Santos
,
Renat Nurmukhametov
,
Medet Donasov
,
Gennady Chmutin
,
Egor Chmutin
,
Bipin Chaurasia
,
Sultan Mujib Dabiry
Abstract
Background: Anterior cervical discectomy and fusion (ACDF) is a common surgical intervention for cervical spine pathologies, including disc herniation and spinal stenosis. Despite its efficacy, complications such as paraplegia can occur, often due to hematomas or iatrogenic injuries.
Case Report: A 42-year-old man presented with persistent pain in his cervical spine radiating to his left arm, numbness in his fingers, and limited movement in his cervical spine. Magnetic resonance imaging (MRI) revealed a C6-C7 disc herniation and C5-C6 spinal canal stenosis. ACDF was performed at C6-C7 with a cage and bone autograft, achieving decompression and stabilization. A 47-year-old female patient presented via the emergency department complaining of severe, recurring pain in the cervical spine radiating to the right shoulder and scapula region and headaches. According to the patient, she has been suffering from severe pain, considered a real nuisance, for several months. MRI showed intervertebral disc herniation and foraminal stenosis at the C5-C6 vertebrae. Anterior microsurgical decompression and fusion with a cage were performed at C5-C6.
Conclusion: ACDF effectively restores cervical alignment and dynamics in single-level cervical pathologies, with transient postoperative complications such as dysphagia resolving during recovery. It remains the preferred approach for anterior cervical disc herniation.
1. Jun DS, Baik JM, Lee SK. A case report: white cord syndrome following anterior cervical discectomy and fusion: importance of prompt diagnosis and treatment. BMC Musculoskelet Disord. 2020;21(1):157. doi: 10.1186/s12891-020-3162-3. [PubMed: 32164644]. [PubMed Central: PMC7066844].
2. Wong JJ, Côté P, Quesnele JJ, Stern PJ, Mior SA. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J. 2014;14(8):1781-9. doi: 10.1016/j.spinee.2014.02.032. [PubMed: 24614255].
3. Tobing SD, Aprianto P. Single level anterior cervical discectomy and fusion in multilevel herniated disc, a case report. Ann Med Surg (Lond). 2020;60:708-13. doi: 10.1016/j.amsu.2020.11.064. [PubMed: 33425339]. [PubMed Central: PMC7779959].
4. Karasin B, Grzelak M. Anterior cervical discectomy and fusion: A surgical intervention for treating cervical disc disease. Aorn J. 2021;113(3):237-51. doi: 10.1002/aorn.13329. [PubMed: 33646576].
5. Tsitsopoulos PP, Voronov LI, Zindrick MR, Carandang G, Havey RM, Ghanayem AJ, et al. Biomechanical stability analysis of a stand-alone cage, static and rotational-dynamic plate in a two- level cervical fusion construct. Orthop Surg. 2017;9(3):290-5. doi: 10.1111/os.12339. [PubMed: 28960818]. [PubMed Central: PMC6584158].
6. Scheer JK, Tang JA, Smith JS, Acosta FL, Jr., Protopsaltis TS, Blondel B, et al. Cervical spine alignment, sagittal deformity, and clinical implications: A review. J Neurosurg Spine. 2013;19(2):141-59. doi: 10.3171/2013.4.Spine12838. [PubMed: 23768023].
7. Jouibari MF, Le Huec JC, Ranjbar Hameghavandi MH, Moghadam N, Farahbakhsh F, Khadivi M, et al. Comparison of cervical sagittal parameters among patients with neck pain and healthy controls: A comparative cross-sectional study. Eur Spine J. 2019;28(10):2319-24. doi: 10.1007/s00586-019-06117-8. [PubMed: 31444609].
8. Charalampidis A, Hejrati N, Ramakonar H, Kalsi PS, Massicotte EM, Fehlings MG. Clinical outcomes and revision rates following four-level anterior cervical discectomy and fusion. Sci Rep. 2022;12(1):5339. doi: 10.1038/s41598-022-09389-1. [PubMed: 35351960]. [PubMed Central: PMC8964822].
9. Liang W, Xiong Y, Jia Y, Li S, Zhao K, Peng Z, et al. Anterior cervical discectomy and fusion for the treatment of giant cervical disc herniation. J Orthop Surg Res. 2023;18(1):683. doi: 10.1186/s13018-023-04036-5. [PubMed: 37705025]. [PubMed Central: PMC10500809].
10. Encarnación Santos D, Bozkurt I, Pachev M, Chmutin G, Rubenoviich-Chicara D, Chaurasia B, et al. Degenerative cervical spondylolisthesis: A comprehensive systematic review in diagnosis, management, and outcomes. Oman Med J. 2025. doi: 10.5001/omj.2026.43.
11. Encarnacion-Santos D, Chmutin G, Abdurakhmonov S, Bozkurt I, Geraldino EB, Prakash S, et al. Current concepts, management, and outcomes of traumatic spinal cord injury: A systematic review and meta-analysis. Int J Orthop surg. 2024;32(2):71-82. doi: 10.4103/ijors.ijors_17_24.
12. Encarnación Santos D, Scalia G, Bozkurt I, Volovish A, Tapia Sierra A, Wellington J, et al. Current insights and surgical interventions in craniovertebral junction instability: A systematic review and meta-analysis. Rom Neurosurg. 2024;38(2):180-8. doi: 10.33962/roneuro-2024-031.
13. Cho DY, Liau WR, Lee WY, Liu JT, Chiu CL, Sheu PC. Preliminary experience using a polyetheretherketone (PEEK) cage in the treatment of cervical disc disease. Neurosurgery. 2002;51(6):1343-49; discussion 9-50. [PubMed: 12445338].
14. Farrokhi MR, Nikoo Z, Gholami M, Hosseini K. Comparison between acrylic cage and polyetheretherketone (PEEK) cage in single-level anterior cervical discectomy and fusion: A randomized clinical trial. Clin Spine Surg. 2017;30(1):38-46. doi: 10.1097/bsd.0000000000000251. [PubMed: 28107234].
15. Kapetanakis S, Thomaidis T, Charitoudis G, Pavlidis P, Theodosiadis P, Gkasdaris G. Single anterior cervical discectomy and fusion (ACDF) using self- locking stand-alone polyetheretherketone (PEEK) cage: evaluation of pain and health-related quality of life. J Spine Surg. 2017;3(3):312-22. doi: 10.21037/jss.2017.06.21. [PubMed: 29057338]. [PubMed Central: PMC5637207].
16. Klingler JH, Krüger MT, Sircar R, Kogias E, Scholz C, Volz F, et al. PEEK cages versus PMMA spacers in anterior cervical discectomy: comparison of fusion, subsidence, sagittal alignment, and clinical outcome with a minimum 1-year follow-up. ScientificWorldJournal. 2014;2014:398396. doi: 10.1155/2014/398396. [PubMed: 25110734]. [PubMed Central: PMC4106069].
17. Shiban E, Gapon K, Wostrack M, Meyer B, Lehmberg J. Clinical and radiological outcome after anterior cervical discectomy and fusion with stand-alone empty polyetheretherketone (PEEK) cages. Acta Neurochir (Wien). 2016;158(2):349-55. doi: 10.1007/s00701-015-2630-2. [PubMed: 26620448].
18. Lied B, Sundseth J, Helseth E. Immediate (0-6 h), early (6-72 h) and late (>72 h) complications after anterior cervical discectomy with fusion for cervical disc degeneration; discharge six hours after operation is feasible. Acta Neurochir (Wien). 2008;150(2):111-8; discussion 8. doi: 10.1007/s00701-007-1472-y. [PubMed: 18066487].
19. Lied B, Roenning PA, Sundseth J, Helseth E. Anterior cervical discectomy with fusion in patients with cervical disc degeneration: A prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage). BMC Surg. 2010;10:10. doi: 10.1186/1471-2482-10-10. [PubMed: 20302673]. [PubMed Central: PMC2853514].
20. Ahmed AF, Al Dosari MAA, Al Kuwari A, Khan NM. The outcomes of stand alone polyetheretherketone cages in anterior cervical discectomy and fusion. Int Orthop. 2021;45(1):173-80. doi: 10.1007/s00264-020-04760-1. [PubMed: 32803359]. [PubMed Central: PMC7801300].
21. Lee YJ, Cho PG, Kim KN, Kim SH, Noh SH. Risk factors of unplanned readmission after anterior cervical discectomy and fusion: A systematic review and meta-analysis. Yonsei Med J. 2022;63(9):842-9. doi: 10.3349/ymj.2022.63.9.842. [PubMed: 36031784]. [PubMed Central: PMC9424775].
22. Wen Z, Lu T, Wang Y, Liang H, Gao Z, He X. Anterior cervical corpectomy and fusion and anterior cervical discectomy and fusion using titanium mesh cages for treatment of degenerative cervical pathologies: A literature review. Med Sci Monit. 2018;24:6398-404. doi: 10.12659/msm.910269. [PubMed: 30208015]. [PubMed Central: PMC6147051].
23. ChenYC,ZhangL,LiEN,DingLX,ZhangGA,HouY,etal.Late deep cervical infection after anterior cervical discectomy and fusion: a case report and literature review. BMC Musculoskelet Disord. 2019;20(1):437. doi: 10.1186/s12891-019-2783-x. [PubMed: 31554516]. [PubMed Central: PMC6761726].
24. Guan L, Hai Y, Yang JC, Zhou LJ, Chen XL. Anterior cervical discectomy and fusion may be more effective than anterior cervical corpectomy and fusion for the treatment of cervical spondylotic myelopathy. BMC Musculoskelet Disord. 2015;16:29. doi: 10.1186/s12891-015-0490-9. [PubMed: 25881246]. [PubMed Central: PMC4344784].
25. Buddappa S, Barooah RK, Baishya BK, Afshangian F, Encarnacion-Santos D, Scalia G, et al. Isolated intramedullary spinal neurenteric cysts: Case report and literature review. Asian J Neurosurg. 2025;20(2):408-12. doi: 10.1055/s-0045-1806727. [PubMed: 40485792]. [PubMed Central: PMC12136934].
26. OzturkY,OcalO,Encarnacion-SantosDA,OzdemirKT,Bozkurt I, Chmutin G, et al. Spontaneous regression of a lumbar juxtafacet cyst: A case report and literature review. Indian J Pain. 2025;39(1):45-8. doi: 10.4103/ijpn.ijpn_90_24.
27. Encarnación Santos D, Chmutin G, Chmutin E, Nurmukhametov R, Dosanov M, Yangi K, et al. Lumbar isthmic spondylolisthesis: comparative insights into patient selection, surgical techniques, and clinical outcomes. Sri Lanka J Surg. 2025;43(2):25-32. doi: 10.4038/sljs.v43i2.9257.
2. Wong JJ, Côté P, Quesnele JJ, Stern PJ, Mior SA. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J. 2014;14(8):1781-9. doi: 10.1016/j.spinee.2014.02.032. [PubMed: 24614255].
3. Tobing SD, Aprianto P. Single level anterior cervical discectomy and fusion in multilevel herniated disc, a case report. Ann Med Surg (Lond). 2020;60:708-13. doi: 10.1016/j.amsu.2020.11.064. [PubMed: 33425339]. [PubMed Central: PMC7779959].
4. Karasin B, Grzelak M. Anterior cervical discectomy and fusion: A surgical intervention for treating cervical disc disease. Aorn J. 2021;113(3):237-51. doi: 10.1002/aorn.13329. [PubMed: 33646576].
5. Tsitsopoulos PP, Voronov LI, Zindrick MR, Carandang G, Havey RM, Ghanayem AJ, et al. Biomechanical stability analysis of a stand-alone cage, static and rotational-dynamic plate in a two- level cervical fusion construct. Orthop Surg. 2017;9(3):290-5. doi: 10.1111/os.12339. [PubMed: 28960818]. [PubMed Central: PMC6584158].
6. Scheer JK, Tang JA, Smith JS, Acosta FL, Jr., Protopsaltis TS, Blondel B, et al. Cervical spine alignment, sagittal deformity, and clinical implications: A review. J Neurosurg Spine. 2013;19(2):141-59. doi: 10.3171/2013.4.Spine12838. [PubMed: 23768023].
7. Jouibari MF, Le Huec JC, Ranjbar Hameghavandi MH, Moghadam N, Farahbakhsh F, Khadivi M, et al. Comparison of cervical sagittal parameters among patients with neck pain and healthy controls: A comparative cross-sectional study. Eur Spine J. 2019;28(10):2319-24. doi: 10.1007/s00586-019-06117-8. [PubMed: 31444609].
8. Charalampidis A, Hejrati N, Ramakonar H, Kalsi PS, Massicotte EM, Fehlings MG. Clinical outcomes and revision rates following four-level anterior cervical discectomy and fusion. Sci Rep. 2022;12(1):5339. doi: 10.1038/s41598-022-09389-1. [PubMed: 35351960]. [PubMed Central: PMC8964822].
9. Liang W, Xiong Y, Jia Y, Li S, Zhao K, Peng Z, et al. Anterior cervical discectomy and fusion for the treatment of giant cervical disc herniation. J Orthop Surg Res. 2023;18(1):683. doi: 10.1186/s13018-023-04036-5. [PubMed: 37705025]. [PubMed Central: PMC10500809].
10. Encarnación Santos D, Bozkurt I, Pachev M, Chmutin G, Rubenoviich-Chicara D, Chaurasia B, et al. Degenerative cervical spondylolisthesis: A comprehensive systematic review in diagnosis, management, and outcomes. Oman Med J. 2025. doi: 10.5001/omj.2026.43.
11. Encarnacion-Santos D, Chmutin G, Abdurakhmonov S, Bozkurt I, Geraldino EB, Prakash S, et al. Current concepts, management, and outcomes of traumatic spinal cord injury: A systematic review and meta-analysis. Int J Orthop surg. 2024;32(2):71-82. doi: 10.4103/ijors.ijors_17_24.
12. Encarnación Santos D, Scalia G, Bozkurt I, Volovish A, Tapia Sierra A, Wellington J, et al. Current insights and surgical interventions in craniovertebral junction instability: A systematic review and meta-analysis. Rom Neurosurg. 2024;38(2):180-8. doi: 10.33962/roneuro-2024-031.
13. Cho DY, Liau WR, Lee WY, Liu JT, Chiu CL, Sheu PC. Preliminary experience using a polyetheretherketone (PEEK) cage in the treatment of cervical disc disease. Neurosurgery. 2002;51(6):1343-49; discussion 9-50. [PubMed: 12445338].
14. Farrokhi MR, Nikoo Z, Gholami M, Hosseini K. Comparison between acrylic cage and polyetheretherketone (PEEK) cage in single-level anterior cervical discectomy and fusion: A randomized clinical trial. Clin Spine Surg. 2017;30(1):38-46. doi: 10.1097/bsd.0000000000000251. [PubMed: 28107234].
15. Kapetanakis S, Thomaidis T, Charitoudis G, Pavlidis P, Theodosiadis P, Gkasdaris G. Single anterior cervical discectomy and fusion (ACDF) using self- locking stand-alone polyetheretherketone (PEEK) cage: evaluation of pain and health-related quality of life. J Spine Surg. 2017;3(3):312-22. doi: 10.21037/jss.2017.06.21. [PubMed: 29057338]. [PubMed Central: PMC5637207].
16. Klingler JH, Krüger MT, Sircar R, Kogias E, Scholz C, Volz F, et al. PEEK cages versus PMMA spacers in anterior cervical discectomy: comparison of fusion, subsidence, sagittal alignment, and clinical outcome with a minimum 1-year follow-up. ScientificWorldJournal. 2014;2014:398396. doi: 10.1155/2014/398396. [PubMed: 25110734]. [PubMed Central: PMC4106069].
17. Shiban E, Gapon K, Wostrack M, Meyer B, Lehmberg J. Clinical and radiological outcome after anterior cervical discectomy and fusion with stand-alone empty polyetheretherketone (PEEK) cages. Acta Neurochir (Wien). 2016;158(2):349-55. doi: 10.1007/s00701-015-2630-2. [PubMed: 26620448].
18. Lied B, Sundseth J, Helseth E. Immediate (0-6 h), early (6-72 h) and late (>72 h) complications after anterior cervical discectomy with fusion for cervical disc degeneration; discharge six hours after operation is feasible. Acta Neurochir (Wien). 2008;150(2):111-8; discussion 8. doi: 10.1007/s00701-007-1472-y. [PubMed: 18066487].
19. Lied B, Roenning PA, Sundseth J, Helseth E. Anterior cervical discectomy with fusion in patients with cervical disc degeneration: A prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage). BMC Surg. 2010;10:10. doi: 10.1186/1471-2482-10-10. [PubMed: 20302673]. [PubMed Central: PMC2853514].
20. Ahmed AF, Al Dosari MAA, Al Kuwari A, Khan NM. The outcomes of stand alone polyetheretherketone cages in anterior cervical discectomy and fusion. Int Orthop. 2021;45(1):173-80. doi: 10.1007/s00264-020-04760-1. [PubMed: 32803359]. [PubMed Central: PMC7801300].
21. Lee YJ, Cho PG, Kim KN, Kim SH, Noh SH. Risk factors of unplanned readmission after anterior cervical discectomy and fusion: A systematic review and meta-analysis. Yonsei Med J. 2022;63(9):842-9. doi: 10.3349/ymj.2022.63.9.842. [PubMed: 36031784]. [PubMed Central: PMC9424775].
22. Wen Z, Lu T, Wang Y, Liang H, Gao Z, He X. Anterior cervical corpectomy and fusion and anterior cervical discectomy and fusion using titanium mesh cages for treatment of degenerative cervical pathologies: A literature review. Med Sci Monit. 2018;24:6398-404. doi: 10.12659/msm.910269. [PubMed: 30208015]. [PubMed Central: PMC6147051].
23. ChenYC,ZhangL,LiEN,DingLX,ZhangGA,HouY,etal.Late deep cervical infection after anterior cervical discectomy and fusion: a case report and literature review. BMC Musculoskelet Disord. 2019;20(1):437. doi: 10.1186/s12891-019-2783-x. [PubMed: 31554516]. [PubMed Central: PMC6761726].
24. Guan L, Hai Y, Yang JC, Zhou LJ, Chen XL. Anterior cervical discectomy and fusion may be more effective than anterior cervical corpectomy and fusion for the treatment of cervical spondylotic myelopathy. BMC Musculoskelet Disord. 2015;16:29. doi: 10.1186/s12891-015-0490-9. [PubMed: 25881246]. [PubMed Central: PMC4344784].
25. Buddappa S, Barooah RK, Baishya BK, Afshangian F, Encarnacion-Santos D, Scalia G, et al. Isolated intramedullary spinal neurenteric cysts: Case report and literature review. Asian J Neurosurg. 2025;20(2):408-12. doi: 10.1055/s-0045-1806727. [PubMed: 40485792]. [PubMed Central: PMC12136934].
26. OzturkY,OcalO,Encarnacion-SantosDA,OzdemirKT,Bozkurt I, Chmutin G, et al. Spontaneous regression of a lumbar juxtafacet cyst: A case report and literature review. Indian J Pain. 2025;39(1):45-8. doi: 10.4103/ijpn.ijpn_90_24.
27. Encarnación Santos D, Chmutin G, Chmutin E, Nurmukhametov R, Dosanov M, Yangi K, et al. Lumbar isthmic spondylolisthesis: comparative insights into patient selection, surgical techniques, and clinical outcomes. Sri Lanka J Surg. 2025;43(2):25-32. doi: 10.4038/sljs.v43i2.9257.
| Files | ||
| Issue | Vol 12 No 1 (2026) | |
| Section | Case Report | |
| Keywords | ||
| Cervical Vertebrae Spinal Fusion Spinal Stenosis Discectomy Intervertebral Disc Displacement | ||
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How to Cite
1.
Encarnación-Santos D, Nurmukhametov R, Donasov M, Chmutin G, Chmutin E, Chaurasia B, Dabiry S. Anterior Cervical Discectomy and Fusion: A Two-Case Series and Literature Review on Management and Outcomes. J Orthop Spine Trauma. 2026;12(1):60-3.
