What is Two-Level ACDF Surgery?

A 2 level ACDF surgery is a specialized procedure that addresses spinal problems affecting two adjacent disc spaces in your neck. Unlike single-level ACDF, which focuses on one disc, this procedure removes two damaged discs and fuses three vertebrae together. Think of it as repairing two consecutive “links” in the chain of bones that make up your cervical spine.

During a two-level ACDF, your surgeon accesses the cervical spine through a small incision in the front of your neck. They carefully remove the damaged discs that are causing pressure on your spinal cord or nerve roots. After removing the problematic discs, they insert bone grafts or spacers into both disc spaces and secure them with plates and screws, allowing the vertebrae to fuse over time.

Who Needs Two-Level ACDF Surgery?

Two-level ACDF surgery is an option when conservative treatments fail to relieve neurological symptoms and/or neck pain from multiple levels of the spine. You might be a candidate for this procedure if you’re experiencing arm pain/numbness/weakness, lost hand coordination, balance difficulty, or bladder/bowel difficulty. These symptoms often indicate more complex cervical spine issues that require intervention at multiple levels to achieve optimal results.

The most common conditions that cause symptoms leading to this procedure include herniated discs, degenerative disc disease, and cervical spondylosis across more than one disc level.

The Surgical Process: What to Expect

Pre-Surgery Preparation

Preparing for a 2 level ACDF involves several important steps. Your surgical team will conduct a comprehensive medical evaluation, including advanced imaging studies like MRI and CT scans. You’ll also discuss your medical history and current medications in detail. Your surgeon will then provide specific pre-operative instructions, including guidelines about medications. This thorough preparation helps ensure the best possible outcome for your surgery.

During a Two Level ACDF Surgery

The surgical procedure follows a carefully planned sequence that typically takes 2 hours to complete. General anesthesia is initiated with monitoring of your neurological function. A small incision is made in the front of your neck. Through careful dissection, structures in the front of your neck are mobilized to access the spine. The damaged discs are meticulously removed, followed by the placement of bone grafts or spacers. The spine is then secured with a plate and screws, providing immediate stability while your body begins the natural fusion process.

Recovery Timeline and Expectations

The recovery journey after two-level ACDF surgery progresses through several distinct phases. During the immediate post-surgery period, you may remain in the hospital for monitoring but these procedures are also performed on an outpatient basis. Your medical team will help manage any postoperative pain and monitor your swallowing function.

The early recovery phase, spanning 2-6 weeks, focuses on gradual rehabilitation. You may wear a neck brace or collar as prescribed and follow specific wound care instructions. During this time, it’s crucial to avoid lifting heavy objects or making sudden neck movements. Most patients can begin returning to light activities while respecting these restrictions.

As you move into the intermediate recovery phase (6-12 weeks), physical therapy comes into play. You’ll gradually increase your activity levels, and many patients can return to desk work during this period. The fusion process continues throughout this time, requiring ongoing patience and adherence to your recovery protocol.

Long-term recovery lasts 3-12 months, during which complete bone fusion occurs. Throughout this period, you’ll have regular follow-up appointments to monitor your progress and adjust your activity levels accordingly.

Potential Risks and Complications

• Temporary swallowing difficulties
• Voice changes or hoarseness
• Infection (rare)
• Hardware complications (uncommon)
• Adjacent segment disease: spinal levels above or below the fusion experience accelerated wear and tear due to increased stress on these segments after surgery
• Pseudoarthrosis (incomplete fusion): the vertebrae fail to fully fuse together, potentially causing instability or persistent pain

Success Rates and Outcomes

The success rates for a 2 level ACDF are particularly encouraging for patients considering this procedure. Clinical studies have shown remarkable effectiveness in pain relief, with 93-100% of patients experiencing significant improvement in arm pain and 73-83% reporting substantial relief from neck pain. These high success rates demonstrate why this procedure has become a favored treatment for multiple-level cervical spine conditions.

Several key factors can influence your surgical outcome and recovery success, including:

• Age: Biological age plays a role in healing capacity, though this procedure has shown positive results across various age groups.
• Overall health status: Factors like bone density, cardiovascular health, and immune system function can impact your body’s ability to heal and fuse the vertebrae properly.
• Adherence to postoperative instructions: Following physical therapy protocols and activity restrictions significantly affects long-term success rates.
• Smoking status: Smoking can negatively impact fusion rates and overall outcomes. Non-smokers and those who quit smoking before surgery typically experience better fusion rates and faster healing.
• Maintaining a healthy diet: A diet rich in nutrients is essential for bone healing and supports optimal recovery and fusion success.

Choosing the Right Surgeon

The success of your two-level ACDF surgery significantly depends on the expertise and specialization of your surgical team. As a highly specialized academic group operating in a private practice setting, the team at Neurosurgeons of New Jersey understands that complex procedures like a 2 level ACDF surgery requires both technical excellence and personalized care. Our board-certified, fellowship-trained neurosurgeons are highly skilled, having trained at nationally recognized neurosurgical programs like Columbia University and NYU.

During consultations, we take time to thoroughly discuss your specific case, potential outcomes, and any concerns you may have, ensuring you feel confident and informed about your individualized treatment plan. We encourage patients to seek second opinions to ensure confidence in their treatment plans.

Authors of this Blog: The Ridgewood Spine Team