What it is
An anterior operation in which one or more vertebral bodies are removed, along with the discs above and below, to decompress the spinal cord where the compression extends behind the body itself. The column is then reconstructed with a strut — a cage or bone graft — and held with a plate.
Who it is for
Compression spanning more than one disc level behind a vertebral body: large bone spurs, ossified ligament, retropulsed fracture fragments, tumor or infection destroying the body. It is also used where previous anterior surgery has left persistent compression behind the body.
How it works
Through an anterior approach similar to an ACDF but longer, the discs above and below are removed and the central portion of the vertebral body is taken away, leaving the walls. Compressive tissue behind it is removed under magnification. A strut is placed to restore height and alignment and secured with a plate; posterior fixation is sometimes added for stability.
Recovery
Typically two to four nights in hospital. Swallowing difficulty is more pronounced and longer-lasting than after a single-level ACDF. A collar is often used for a period. Fusion across a reconstructed segment takes longer, and X-rays follow it over months.
Risks and alternatives
All the risks of anterior cervical surgery, with a higher rate of swallowing difficulty, graft or construct settling, and failure of fusion. Injury to the cord or nerves is uncommon but consequential. Alternatives include multi-level ACDF, posterior decompression and fusion, or a combined approach.