Cervical Spine Surgery – Anterior Cervical Discectomy and Fusion (ACDF)
ACDF is a very common spinal operation done by both neurosurgeons and orthopedic surgeons. ACDF is performed for a variety of conditions, including ruptured discs, arthritic changes in the cervical spine and spinal stenosis, a condition where the spinal canal, the space in the vertebrae of the neck where the spinal cord runs, is abnormally small. All of these conditions can press on the spinal cord and nerves, causing neurological symptoms.
In an ACDF, ruptured discs are removed, bony outgrowths (usually from arthritis, called osteophytes or “bone spurs”) are removed and the spinal canal may be enlarged. The vertebrae between the removed discs are held together with a metal plate on the front of the spine, fastened by screws in the upper and lower adjacent vertebrae. Before the plate is screwed in place, the adjacent ends of the vertebrae next to space where the disc was is drilled, and a bone graft is placed between the vertebrae. The purpose of this is to allow the vertebrae, in effect, to grow together and heal with solid bone (called a “fusion”), similar to the way a broken arm bone, for example, heals after a fracture. The metal plate is attached to stabilize the vertebrae while bony fusion occurs, similar to the way a cast would hold a broken bone in the arm in place until it heals.
In certain cases, the same sort of operation can be done using a posterior approach. Instead of a plate on the front of the spine, stabilizing hardware is attached to the back of the spine.
When the operation has been correctly done, and the vertebrae are properly aligned and adequately stabilized, symptoms which were present preoperatively are usually substantially better or relieved entirely soon after the operation. Persistent pain and other symptoms, or worsening or new pain and other new symptoms may indicate that the vertebrae were not properly stabilized. This may happen, for example when the plate is improperly positioned or the screws are not correctly placed into the bone. Postoperative cervical spine x-rays, done at intervals to make sure fusion is taking place, my show lack of bridging of the adjacent vertebrae by new bone, improper positioning of the plate and screws and persistent improper movement of the vertebrae one upon the other.
If the vertebrae do not fuse beyond the time that this would be expected, a “failed fusion” is said to have occurred. A failed fusion may cause severe symptoms. If the cervical vertebrae are not properly stabilized and the surgeon fails to recognize and correct this problem in a timely manner, symptoms may become permanent and uncorrectable, causing profound disability.
Another complication which may occur with cervical spine surgery is a postoperative hemorrhage. Hemorrhage may develop in the few hours following a cervical spine operation. This hemorrhage may be outside the outer fibrous covering of the spinal cord and within the spinal canal and may result in a mass of blood called an “epidural hematoma”, which can compress and damage the spinal cord and nerves. This can result in neurologic symptoms appearing within hours of the operation. If this hematoma is not promptly diagnosed and surgically removed, this is almost always malpractice. Permanent injury to the spinal cord and nerves may result.
In consultation with neurosurgeons, neurologists, neuroradiologists and other physicians, the lawyers at the Sweeney Law Firm will work with medical specialists to analyze medical records, CT scans, MRIs, x-rays and other sources of information to determine if complications of your spinal surgery were caused by malpractice. If so, the Sweeney Law Firm may be able to recover money damages to help pay for medical expenses, rehabilitation expenses, lost income and other expenses, and to help compensate you and your family for the emotional and physical pain and suffering and other damages which may result in these cases.