====== Anterior cervical discectomy and fusion indications ======

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Anterior and posterior approaches are widely employed in DCM when compressive elements predominate in the anterior or posterior spinal cord, respectively. Indications for each approach remain controversial in some contexts.
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[[Anterior cervical discectomy]] and [[fusion]] (ACDF), without and with [[cervical plate]] (ACDF+CP) are accepted surgical techniques for the treatment of degenerative cervical disc disorder.and [[cervical laminoplasty]] (LP) are the most commonly performed procedures for degenerative [[cervical spondylosis]]. 
((Cloward RB: The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:602–617, 1958.))
((Robinson RA, Smith GW: Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull John Hopkins Hosp 96:223–224, 1955.))

[[Interbody fusion]] is performed with [[bone graft]]s or [[interbody cage]]s, and may be supplemented with [[anterior cervical plate]]s.

A study demonstrates that 3- and 4-level ACDF can potentially be performed safely on an outpatient basis, allowing patients to spend less time in the hospital
((Khalid SI, Kelly R, Carlton A, Adogwa O, Kim P, Ranade A, Moreno J, Maasarani 
S, Wu R, Melville P, Citow J. Outpatient and inpatient readmission rates of 3-
and 4-level anterior cervical discectomy and fusion surgeries. J Neurosurg Spine.
2019 Mar 29:1-6. doi: 10.3171/2019.1.SPINE181019. [Epub ahead of print] PubMed
PMID: 30925482.
)).


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Once conservative treatment for [[cervical radiculopathy]], [[cervical spondylotic myelopathy]], or both, has failed, surgical intervention is indicated
((Sonntag VK, Han PP, Vishteh AG. Anterior cervical discectomy. Neurosurgery. 2001 Oct;49(4):909-12. PubMed PMID: 11564253.)).

It has been shown that ACDF induces biomechanical changes leading to modifications of intradiscal pressure
pressure recordings in the cervical spine
((POSPIECH J, STOLKE D, WILKE HJ, CLAES LE. Intradiscal pressure recordings in the cervical spine. J Neu- rosurg 1999; 44: 379-385.))
((WEINHOFFER SL, GUYER RD, HERBERT M, GRIFFITH SL. Intradiscal pressure measurements above an in- strumented fusion. A cadaveric study. Spine 1995; 20: 526-531.))
((WIGFIELD CC, SKRZYPIEC D, JACKOWSKI A, ADAMS MA. Internal stress distribution in cervical interverte- bral discs: the influence of an artificial cervical joint and simulated anterior interbody fusion. J Spinal Disord Tech 2003; 16: 441-449.))
and to increased stress and motion of vertebral segments adjacent to the fused ones.

see [[Anterior cervical discectomy and fusion for cervical spondylotic myelopathy]].