Neck · Cervical spine
Anterior Cervical Discectomy & Fusion ACDF
ACDF is an operation to remove a herniated disc in the neck through a small incision on the front of the neck, then fuse the two vertebrae so the segment is stable.
Kornelis Poelstra, MD, PhD performs ACDF for patients in Lakeland, FL and across Central Florida, including the Tampa Bay and Orlando areas.
Understanding the problem
Why ACDF may be needed: a disc pressing on a nerve
Normal discs
The cervical spine consists of the bony vertebrae, discs, nerves and other structures. The vertebrae, which stack up to create your spinal column, surround and protect your spinal cord. The discs are located between each vertebra. Discs consist of a fibrous outer layer (annulus) surrounding a gelatinous center (nucleus). They allow motion between vertebrae, act as shock absorbers, and distribute the stress and strain placed on your spine.
Herniated discs
When a disc weakens, the outer layer may not be able to hold the center of the disc in place and the disc may bulge, which can irritate nerves. In advanced cases it may rupture (herniate) through the annulus and pinch the spinal nerves. This can cause numbness, weakness and/or pain which radiate down the arm into the hand, or difficulty with fine motor movements. If pressure on the spinal nerves continues, nerve damage can occur and cause numbness or muscle weakness as well.
Most patients with herniated discs do well without surgery; however a small percentage may require surgery. There are rare circumstances in which some patients require immediate surgery, such as progressive neurologic loss like increasing weakness or paralysis.
The surgery
How ACDF surgery is performed
Anterior Cervical Discectomy & Fusion (ACDF) is an operation to remove a herniated disc (discectomy) in the neck. The surgery involves a 3–4 inch diagonal incision on the front (anterior) of your neck. Because the incision follows a natural skin fold, the resulting scar is often very cosmetic.
The surgeon protects the nerve roots and removes the herniated disc to relieve pressure on the nerve. Next, bone graft is placed where the disc was, allowing the two vertebrae to grow together as one (fusion). Finally, a small metal plate may be screwed into place to hold the bone graft while the fusion heals.
The goal of this surgery is to relieve arm and hand pain, numbness, weakness, or lack of coordination and fine motor control caused by pressure on the nerves.
The surgery typically lasts 2–2½ hours, depending on the number of discs operated on, whether previous surgery has been performed, and the severity of pressure on the nerves. Blood loss is usually minimal, so blood donations are generally not needed before the operation. Most patients go home one to two days after surgery.
The most common complaint after this surgery is difficulty swallowing, caused by the gentle movement of the throat structures needed to reach the spine. This usually resolves over a few weeks, but you may need to eat only liquids or soft foods during that period.
Patients usually wear a collar for 2–6 weeks. Sleeping upright for about one week after surgery can help reduce swelling in the neck.
Already have an MRI? Find out if you may be a candidate with a video review from Dr. Poelstra.
Risks
Risks of ACDF surgery
Surgery and anesthesia involve stresses to many organs and tissues in the body. Incisions and handling tissues during surgery can result in problems. The benefits of surgery must be carefully weighed against these risks. Some of the more common or serious problems are listed here.
Spinal cord or nerve root injury
Permanent injury to the spinal cord or nerve roots is extremely rare. It is not unusual, however, to experience minor temporary tingling, numbness, weakness or pain which resolves over several weeks. All precautions are taken, but rarely more serious nerve injuries may occur, affecting walking, balance, or bowel or bladder function.
Failure of fusion
On rare occasions the bone graft does not heal properly. The likelihood of this is greatly increased by smoking or using nicotine of any kind. This can cause the hardware to fail and the bone graft to shift, and additional surgery may be needed. We recommend quitting smoking at least one month before surgery and not smoking for at least 3 months after. Smoking also speeds degeneration of the spine and increases the chance of needing treatment at another level of the neck.
Dural tear
Leakage of spinal fluid can occur due to a tear in the tissue (the dura) that holds the spinal fluid and surrounds the nerves. On rare occasions additional surgery may be needed.
Infection
Infection is always a post-operative risk and occurs in approximately 1–2% of surgical patients, varying by surgery type. Infections may be superficial or deep into the bone. You are given antibiotics before and after surgery to help prevent this. Please follow the wound care instructions to help prevent infection.
Airway compromise
Extremely rarely, swelling within the neck can cause difficulty breathing. If this occurs in the hospital, a breathing tube may need to be kept in place. If it occurs at home, it is an emergency: call 911 or go to the nearest emergency room.
Other complications
Other possible complications include blood clots, pneumonia and complications related to general anesthesia. Hoarseness and/or swallowing problems may last for several weeks. Please call us if this persists.
Recovery
ACDF recovery timeline
- First week
Sleep upright to help reduce swelling. Soft foods if swallowing is uncomfortable.
- First visit
Wound check and stitch removal if needed. Walking about 15 minutes twice a day.
- 2–3 weeks
Incision pain usually improving. No driving until cleared, typically about 3 weeks.
- 2–6 weeks
Collar as directed. Walking 30–40 minutes twice a day by around six weeks.
Activities and exercise
Rehabilitation is an important part of recovery. Many patients have had spinal pain for some time, which can weaken the spinal muscles, so return to your normal activities slowly.
The main form of rehabilitation after surgery is a walking program. Start after discharge and walk a little more each day, generally two to three times per day. Many patients are walking about 15 minutes twice a day by their first post-operative visit, and 30–40 minutes twice a day by about six weeks after surgery, as directed by your surgeon.
Expectations
Many patients notice a reduction in arm pain after surgery. If the nerve has been irritated for a long time, improvement may be more gradual. As the nerve heals, tingling or a warm feeling is common. Strength often improves next. Numbness in the arm or hand is usually the last to improve and, if present for a long time before surgery, may not fully resolve. Every patient's recovery is different.
Neck pain from the incision usually improves within two to three weeks. Increased pain with prolonged sitting and driving is also expected, and for safety we recommend not driving for approximately three weeks, or until your surgeon clears you.
Aftercare
Caring for yourself at home after ACDF
Wound care
- At your first post-operative visit we will inspect your wound and remove any stitches as needed.
- Do not soak your wound: no bathtub, swimming or hot tub until your surgeon says it is OK. Do not remove any butterfly strips next to your skin; they are designed to get wet and fall off in the shower over time.
- If you have a clear plastic bandage over your wound, you may shower right away. You may remove the clear plastic once home, then shower as described below.
- If you have a gauze dressing instead, do not shower until 72 hours after surgery, and only if the bandage has no wet drainage on it.
- To shower: remove the outer gauze bandage and shower as usual. Blot the incision dry, then cover it with a clean, dry bandage.
Medications
Prescribed narcotic pain medication may cause constipation. Increase your fluid and fiber intake (fruits, vegetables, whole grains) and walk as much as possible.
If you need a refill, please have your pharmacy send the refill request to our office and allow up to 48 hours for it to be processed. Refills are not filled after hours, on weekends or on holidays, so keep track of how much medication you have and request refills before you run out.
Activity limitations
Avoid twisting your neck to the extremes, and avoid forced bending of your neck forward or backward. Gentle range of motion of the neck is OK. Do not drive until your surgeon has cleared you.
Questions
ACDF surgery: frequently asked questions
How long does ACDF surgery take?
ACDF typically takes about 2 to 2½ hours. The time depends on how many discs are treated, whether you have had neck surgery before, and how much pressure there is on the nerves.
How long will I stay in the hospital after ACDF?
Most patients go home one to two days after surgery. Your surgeon will decide when it is safe for you to go home.
Will I need to wear a neck collar after ACDF?
Patients usually wear a collar for about 2 to 6 weeks. Your surgeon will tell you how long you need it.
When can I drive after ACDF?
For safety, we recommend not driving for approximately three weeks after ACDF, and not until your surgeon has cleared you.
Is trouble swallowing normal after ACDF?
Difficulty swallowing is the most common complaint after ACDF. It usually improves over a few weeks, and you may need to eat liquids or soft foods during that time. Call us if it does not improve.
Does smoking affect ACDF?
Yes. Smoking or using nicotine of any kind greatly increases the chance that the fusion does not heal properly. We recommend stopping at least one month before surgery and not smoking for at least three months after.
Do I need surgery for a herniated disc in my neck?
Not always. Most patients with herniated discs do well without surgery, using time, anti-inflammatory medication, physical conditioning, traction or injections. Surgery may be considered when symptoms continue or nerve function gets worse.
What is the difference between ACDF and artificial disc replacement?
Both remove the damaged disc from the front of the neck. ACDF replaces it with a spacer and fuses the two vertebrae together. Artificial disc replacement uses a mechanical disc designed to preserve motion at that level. Which option is appropriate can only be decided after an in-person evaluation.
Your surgeon
Kornelis Poelstra, MD, PhD
Orthopedic & Neurological Spine Surgeon
- Board Certified, American Board of Orthopaedic Surgery
- PhD in Biomedical Engineering, University of Groningen
- Orthopaedic residency, University of Virginia
- Spine fellowship, Rothman Institute, Thomas Jefferson University
Every patient is different. This page is general information, not medical advice, and is not a promise of any particular result. Whether surgery is right for you, and which procedure, can only be decided after an in-person evaluation with a surgeon. All surgery carries risks, which Dr. Poelstra will review with you. Illustrations are for general education only.
Wondering if ACDF is right for you?
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Patient stories
What our patients are saying
In their own words, from patients treated by Dr. Poelstra. Rated 4.5 on Google from 43 reviews.
Talk about having confidence in my surgeon and the PA! I did not even meet my specialists until right before my surgery! I had read about Dr. Poelstra online and had every bit of confidence in him. It is not very often you meet a doctor who is very knowledgeable, explains what he is going to do and what he had to do, but he was truly concerned about me.
Outstanding doctor!!!! Went to my first visit and wow he was absolutely awesome. He thoroughly explained to me everything about my case and I knew the first time when I left his office I was very confident he was the right surgeon.
Just had a complex cervical spine surgery performed by Dr. Poelstra. My osteoporosis certainly made the surgery more of a challenge. Dr. Poelstra devoted a lot of time and attention to my particular problems before coming up with a solution. Am also thrilled to report not only did the surgery go well, but I have experienced zero pain and am still pain free, 3 weeks post-surgery.
Most amazing doctor. We travelled from New Mexico for my husband’s back surgery. We believed in his evaluation, but his skill and compassion excelled. Dr Polestra did an extensive surgery and the outcome was much better than we had dared to hope.
I did extensive research prior to my ACDF surgery and consulted with 3 other surgeons. Those 3 felt like a transaction. Then I was referred to Dr. Poelstra by a different Doctor.
From my consultation to my post-op appointments, Dr. Poelstra provided world class care. Dr. Poelstra is gifted and his immense expertise and meticulous attention to details is evident. Dr. Poelstra is incredibly kind and genuine. He greets with a warm smile at each appointment, taking the time to truly listen and ensure I felt comfortable.
It is rare to find a surgeon who pairs such high-level brilliance with such a sincere human touch.
I HIGHLY recommend him to anyone who is seeking the best possible care.
For about 3 years I have had a complicated life due to pain in my back and hands, loss of balance, and falls. I visited orthopedists and neurologists, but they did not give me a solution that convinced me. I met Dr. Poelstra, and he knew how to give me a good solution. Finally, I had my surgery, and I can assure you that since then my pain has disappeared, my balance has returned, and I have regained some strength in my hands. Thank you, Dr. Poelstra, for helping me recover my quality of life.
I went to see Dr Poelstra for a second opinion because I had severe neck pain with numbness and pain radiating across my shoulder, down my left arm with constant headaches for over 6 months. Dr. Poelstra reviewed my MRI suggested ACDF surgery, Anterior Cervical Discectomy and Fusion surgery. He stated that I had 2 ruptured discs, C5-C6 and C6-C7 and the discs were pushing my spinal cord to the back and right. I am now 3 weeks post surgery and feel terrific! I woke up from surgery with ZERO pain. I was absolutely surprised that I had no pain.
Dr. Poelstra has an amazing bed side manner and did an excellent job! I’m so happy and relieved that my pain is gone.
I was initially scheduled to have my surgery though another doctor, but after my 2nd visit I was told I was be seeing Dr. Polestra and he left the exam room for abou 10-Minutes. In that time I Googled Dr. Polestra and was floored by his excellent reviews. His experience in robotic surgery is unmatched. He has done robotic spine surgeries than anyone on the planet, period (It's a fact) Anyway, I had been dealing with a bad back, more specifically L3-S1 from an injury sustained in 1985, yes, 1985. Finally in 2024 It was done. It got too bad to bear, the pain was too much. I was super anxious as he told me it would be two surgeries. 1 entering through the belly and two days later through the back. Two surgeries had me second guessing the whole thing. The morning of the surgery as I laid there waiting to be wheeled in Dr. Polestra came by to talk to me. He was excellent at making me feel better about the surgeries. He explained it all again and why he chose (chooses) to do double surgery in these cases. I felt way better and he made sure of that before walking away. Dr Polestra has a very calming and uniquely cool personality. I am a bit of a personality and he stood toe to toe. Haha. The 1st and 2nd surgeries were a complete success. (Dec 11th & 13th 2024) I was up walking around after both surgeries. i was honestly worried about pain levels post-surgery. I shouldn't have been. Post Op pain was incredibly low considering. Dr. Polestra and his PA saw me 2 times in the 4 days in the hopital. Each time ensured any questions I had were answered. He made certain to let me know where he expected me to be and where I was each time. I liked that a lot.
15 Month Post Op update 3/17/2026: No back pain since surgery. Mobility is great and no issues. I feel like a truly lucky person having had Dr. Polestra for my surgeries. So many years of pain and my back going out to no pain and my back not going out. Feeling today as if I won the back surgery lotto. If you have Dr. Polestra consider yourself luckily and stick with him. Brilliant
I recently had my spine surgery with Dr. Poelstra. He did a phenomenal job. I feel so much better. He was very caring through the whole process. I would recommend him to anyone looking for spinal surgery.
I came to his office after 13 years of not being able to sit or stand up, straight or very long. Within a few months and 2 surgeries, I am better than ever and absolutely 💯 no pain and 95% movement. About 5 disc replacements and 2 rods in my back. I had to learn how to walk and sit upright again. I have and will always recommend this man and his assistant. When I talked and explained......they LISTENED. Thank you for your attention and miracles!!
I am beyond happy with this surgeon. After he gave me a spinal fusion from L5-S1, I have strength back in my legs, the pinching of my nerves are gone, I don't feel the knife/stabbing pain in my back and bottom area anymore. He treats his patients so nicely, with dignity and respect. Amazing bedside manor. He advocates for his patients and makes sure you're well taken care of. If I ever need anything in the future, I will be coming back to this doctor. He truly is amazing. I can't recommend him enough.
I came to Dr. Poelstra after going to pain management for over 2 years for him to discover that the bone of my hips had completely deteriorated and I had something called a vascular necrosis. He is absolutely amazing, and a lifesaver. Thank you Dr. Poelstra, because of you I can walk again!
After two years of consistent lower back pain, injections and RFA, I needed a second opinion.
From my first visit, I felt like his family. He took the time to explain his findings, offered conservative suggestions, but ultimately together we decided a single level fusion would offer me the best chance at becoming “mostly” pain free.
I was so impressed by Dr. Poelstra that I read any literature I could find about his surgical approaches and listened to pod casts detailing the latest in medical techniques and equipment.
I am now 3 weeks post operative and I feel better than I have in the last few years! I can stand straight, bend over, twist and simply do things I haven’t been able to do in some time. I am so thankful to have found someone who cares about his profession and his patients so much.
I had the unfortunate need for spinal fusion repair and we found Dr. Poelstra and his team. Rather than viewing my “mess” as a problem he saw it as an opportunity to give me my quality of life back. I had been suffering with chronic back pain for the past six years due to six spinal fusions and their failure to give me the desired result.
Dr Poelstra did an AMAZING job. He did a complete hardware revision which we didn’t think was possible. He is a highly skilled surgeon with the latest robotics technology. He is not only a top surgeon but also a caring and kind humanitarian.
I’m already on the road to recovery after just days with less pain and standing straighter than ever!
Thank you Dr. Poelstra! Highly recommend you!
Dr. Poelstra just did my L-4/5 and rebuilt my L-5/S1. What an amazing surgeon!!!
I feel like a new man, mobility and range of motion is better than ever. Plus his positive energy is very infectious.
A truly gifted surgeon and all around great person!!! 5 Stars forever ⭐️⭐️⭐️⭐️⭐️!!!
No one wants to undergo spinal back surgery, but Dr. Poelstra is an excellent surgeon with an incredible team. I felt very comfortable with his confidence and reassurance regarding my surgery.
A true lifesaver! His knowledge and precision are amazing! My husband had six spinal fusions. He was in so much pain and all they did was give him pain meds and say we can’t do anymore surgeries. Dr. Poelstra was on duty and after looking at his xrays was confident he could fix his problems. There was fluid on his back and broken rods and loose screws. Dr. Poelstra was able to remove almost all of the old hardware and replace it with new. Immediately the pre surgery pain was gone. They are so kind and genuine. And today, less than two weeks later he has minimal post surgery pain. Standing tall and not hunched over. Highly recommend him. I wouldn’t go anywhere else!
Dr Poelstra and his team are the most amazing Surgeons you will ever come across, they with out a doubt saved my husbands life, he had one of the most difficult spine issues that other Dr’s would not touch. Dr Poelstra had a plan executed and it worked beautifully.
Spine surgeon extraordinaire! Ensures that he does exactly what is needed, no more, no less. Lays out the facts, the options, and then lets you decide on how to proceed. No surgeon can foresee the end result, but his confidence and especially his bedside manner put you at ease in making the correct surgical decision.
My husband and I highly recommend Dr. Poelstra. We both had to have back surgery, one year apart. Dr. Poelstra is a brilliant surgeon who utilizes the most high tech cutting edge modalities available, individualized for each case. When I was told he would using robotics during my surgery I was scared and reluctant but the results are amazing. The screw placement is so precise, it looks fake on the x-ray. But here I am, strong and flexible. My husband is a veteran who was wounded severely but the spine issues were never addressed successfully. I took him to Dr. Poelstra who miraculously corrected the issues that plagued him for so long. Dr. Poelstra had to modify certain things due to my husband's abdominal wounds and scar tissue but my husband now stands up straight again and is OUT OF PAIN. He doesn't walk weirdly anymore and feels like a new man. We are so grateful for his expertise, care and humanity.
I am a patient of Dr. Kornelis Poelstra, who performed surgery on my lower lumbar. If you haven't already done so, I suggest first looking up his CV to understand the extent and depth of his experience and education. It's also worth noting that Dr. Poelstra holds a PhD in addition to being a MD which is not the norm. An in-person meeting will demonstrate Dr. Poelstra's expertise and yes, kindness. I thought I had lost my previous life four years ago when my back decided to stop working. Dr. Poelstra just gave it back. Further, his robotics has minimized recovery time. It's an invasive surgery but I'm only two weeks in and already I'm walking around, feeling pretty darn good. I plan on hitting the ski slopes in the near future - imagine that!
With three previous cervical fusions, my upper neck and head bent almost 30° forward. After reviewing my MRIs and x-rays, Dr. Poelstra looked at the overall issue and through surgery was able to pull my head and cervical spine back at least 20° and recenter my head over my shoulders. The surgery was a great success, and I no longer have the stress and strain on my mid and lower back. I feel great, and I am able to look up and forward instead of at the ground. Great job Dr Poelstra! 👍🏻
I have had 2 previous surgeries and needed a doctor with the expertise to help stop my shoulder and arm pain. Dr Poelstra found a more severe issue and talked to me about it and we decided surgery was needed. Dr Poelstra did an amazing job. He worked around my previous surgeries and completely fixed the problem. He is very informative and makes sure you understand and helps you make the decision. Would definitely go to him again. His staff is very professional and caring.
Unbelievable. Efficient, proficient, and effective. He carefully explained the condition of my spine and offered a conservative solution. The first surgeon to offer an explanation of the underlying cause. He did a disc replacement in the morning and I went home the same day. No pain! Slight sore throat for 48 hours until swelling went down a bit. A great experience. Great surgeon and support staff.
Thanks to this wonderful surgeon, I have my husband back. My husband started falling and was unable to control his balance. That is where we met Dr. K. Poelstra, ordering a MRI of Neck/Spine and there it was. As they talked surgery, both my husband and I cringed. But Dr. Poelstra was so knowledgeable and experienced about the ACDF (Anterior cervical discectomy and fusion) procedure. Next day it got done. The next day my husband was up walking, steady on his feet, wanting to go home. I won't lie he had to wear a collar around his neck and no driving for 2 weeks and he had a little sore throat but it was a small price to pay for getting your active life back. I can't say enough about Dr. Poelstra and his amazing staff. Very professional, caring and knowledgeable, three great qualities when dealing with the spine.
I prolonged having surgery for way too long and suffered throughout that time. Dr. Poelstra was still able to increase my quality of life 100 percent. Amazing surgeon and a wonderful person! Thank you
I’ve been fighting terrible back pain for 5 years, plus things were rapidly going for the worse, not to mention I’ve had injections, nerve blocks, pain management, and on and on. I visited 3 doctors total and out of the 3 Dr Poelstra was by far the most knowledgeable, caring, understanding my whole situation. He explained with models of a spine, he showed me exactly what he was going to do right to the end of my surgery. He did an A-LIF and a P-LIF lumbar spine, which is front and back, two surgeries two days apart. I’m 7 weeks post op and my pain level is from above a 10 all day and all night to a 2-5 level and not even being 100% healed I feel like a new person. I can honestly say this man gave me a second chance at my life. I highly recommend Dr Poelstra, this man is honest. It feels good to walk with a smile.
My husband had the robotic back surgery from Doctor Poelstra. He is very knowledgeable in his field of work and very kind. He called me 2xs during the surgery to let me know how everything was going. He and his staff are A+. Highly recommendable!
Dr. P gave me my life back! Before my surgery I couldn't stand or walk for more than 5 minutes. 10 weeks out of surgery and I can stand and walk endlessly. Surgical sore at times, but I will take that over pre-surgery pain any day of the week!
I found him to be very professional, caring and knowledgeable. He showed great concern and was very sympathetic to my situation, after 3 failed surgeries from a previous doctor, I am walking better than before.
My experience with Dr. Poelstra was very pleasant. He knows his craft very well and was very informative. I highly recommend him. Plus he has a nice personality. The surgery seems to have gone well.