As many as 1 in 5 people have complications from ACDF surgery, but severe side effects are rare. Most people fully recover within 6–8 weeks, but some may need another surgery.

Anterior cervical diskectomy and fusion (ACDF) is a neck surgery that involves the removal of a damaged disk. A bone graft then fuses the bones above and below the removed disk. A surgeon fixes this graft in place with metal plates and screws.

ACDF surgery is one of the most common neck operations performed in the United States, with an estimated 137,000 procedures per year. Experts consider it the gold standard for treating conditions like:

The surgery can reduce neck pain and neurological symptoms by relieving pressure on the spinal cord, but it does come with some risk of side effects.

In this article, we take a deeper look at the short- and long-term risks of ACDF surgery.

Complication rates for ACDF surgery are in the range of 13.2–19.3%, according to a 2019 review of studies. Some of the most common complications include:

In some cases, the fusion may not work. This would require another procedure.

In the same 2019 review, the researchers reported the following rates of side effects from studies conducted in 1989–2019.

Side effectRate
difficulty swallowing (dysphagia)1.7–9.5%
postsurgical bruising0.4–5.6% (requiring surgery in 2.4–5.6% of cases)
increased spinal cord compression (myelopathy)0.2–3.3%
recurrent problems with the laryngeal nerve (nerve palsy)0.9–3.1%
cerebrospinal fluid leak0.5–1.7%
infection0.1–1.6%
increased compression of the nerve roots (radiculopathy)1.3%
drooping eyelid, constricted pupil, and loss of facial sweating (Horner syndrome)0.06–1.1%
trouble breathing (respiratory insufficiency)1.1%
perforation of the food pipe (esophagus)0.3–0.9% (death rate 0.1%)
surgical equipment failure0.1–0.9%

ACDF and adjacent segment disease

ACDF surgery can potentially lead to the degeneration of the surrounding disks, a condition called adjacent segment disease (ASD). According to the researchers of a 2021 Finnish study, previous studies examining the rates of ASD after ACDF have reported:

  • about a 1 in 33 chance of developing ASD each year
  • less than a 1 in 50 chance of developing ASD requiring surgery each year
  • about a 1 in 4 lifetime chance of developing ASD

In a previous study by the same researchers, they reported that the yearly chance of developing ASD requiring surgery after ACDF surgery was 1.1% among 476 people who received treatment at Helsinki University Hospital.

In a 2023 study, the researchers reported that 3.6% of people needed surgery to treat long-term side effects, mostly due to ASD.

Unsuccessful ACDF surgery might lead to symptoms such as:

  • neurological problems in your arms or legs, such as:
    • pain
    • numbness
    • tingling
    • trouble moving
  • headaches
  • facial pain
  • dizziness

When to contact a doctor

It’s important to attend all your scheduled follow-up appointments after your surgery to make sure you’re healing as expected. It’s also essential to contact your doctor if you develop any potentially concerning symptoms, such as:

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Your neck will likely be sore and stiff for several days to weeks after your procedure. Your surgeon will give you a list of activities to avoid while you’re recovering, which will likely include:

  • twisting your neck
  • lifting heavy weights
  • using tobacco or alcohol products
  • doing physically demanding activities

You’ll likely be able to return to your regular activities once you’re fully healed, but you’ll no longer be able to bend or twist your neck through the fused segment.

The recovery period for ACDF surgery depends on the extent of your symptoms and your overall health. Doctors often recommend avoiding lifting heavy objects for about 6 weeks and avoiding driving for 2 weeks.

After your surgery, your doctor may fit you with a soft or hard neck brace to limit movement through your neck. You’ll have to wear a hard brace until they tell you to remove it. If you get a soft brace, they’ll likely tell you that you can decrease the amount of time you wear it over 6–8 weeks.

You’ll usually meet with a physical therapist shortly after your surgery, and they’ll give you a series of stretches and exercises to help improve your neck function.

Some ways you may be able to reduce your risk of complications after ACDF surgery include:

  • quitting smoking, ideally at least 4 weeks before your operation
  • making sure diabetes is well controlled before your procedure
  • losing weight before your procedure if you currently have overweight or obesity
  • taking medications as prescribed after your procedure
  • following your surgeon’s recovery instructions

Minimally invasive ACDF procedures performed through small incisions seem to have lower rates of severe bleeding and faster recovery times than traditional surgery.

Many people who have ACDF surgery experience improvements in their symptoms and enjoy a generally higher quality of life.

In the 2021 study, the researchers found that some young adults who had undergone ACDF surgery reported some issues with mobility, pain, and carrying out their regular activities. However, they seemed to be very satisfied with their surgery, and there was no significant difference in employment status compared with people in the general population.

Here are some frequently asked questions that people have about ACDF surgery, recovery, and complications related to the operation.

What percentage of ACDF surgeries are successful?

Success rates for ACDF procedures are in the range of 85–95%.

What’s the most common complication of ACDF?

The most common complication after ACDF surgery is difficulty swallowing. Your esophagus is directly in front of your spine, and this type of surgery usually affects it.

Other common side effects include bruising and spinal cord or nerve root compression.

How long does it take to recover from ACDF?

The recovery time for ACDF surgery depends on the extent of your procedure and your overall health. It’s generally a good idea to avoid lifting heavy objects and excessively turning your neck for 6 weeks.

Can cervical spinal fusion cause problems later in life?

Some people who undergo spinal fusion develop problems with the surrounding vertebrae. If this happens, you may need another surgery.

ACDF surgery is a procedure that involves a surgeon removing a disk from your neck and fusing the bones above and below the removed disk. It can help reduce neck pain or compression of your spinal cord.

Like all surgeries, the ACDF procedure comes with some risks, including bruising, worsened neurological symptoms, and trouble swallowing. Following your postsurgical instructions gives you the best chance of minimizing your side effects.