ACDF Complications

Cervical Spine Anterior ApproachUnfortunately in any surgical intervention, intraoperative or postoperative complications can take place (such as hemorrhages and infections). Any of these complications may lead to temporary or permanent neurological deterioration of the patient’s symptoms or even trigger new symptoms (such as quadriplegia, hoarseness due to paralysis of the recurrent nerve, cervicobrachialgia, and others).

When placing an osteosynthesis devices (cervical fusion) in order to fix fractures, it might occur, as in any hardware, an early or delayed infection or even the necessity of an implant revision of that same fracture.
As well, an arthrodesis (fusion between two bones via surgery) of a joint could favor, at a later time, the degeneration of neighboring joints due to mechanical stress.

Postoperative mortality is unusual, however serious complications can occur if there is an accidental rupture of the carotid artery, jugular vein, esophagus or even a spinal cord injury during cervical anterior approach.

To achieve a good clinical result, it is crucial to have a successful bone fusion between the affected vertebrae. When the bone fusion is not successful, then a pseudo arthrosis may occur which can lead to a reoperation.

ACDF Complications review

ACDF (Anterior Cervical Discectomy Fusion Surgery) is a simple and safe surgical procedure with very few complications.
Dysphagia is the most common complication, but it is inherent to the procedure and in most cases it can be solved without any treatment.
Neither age nor gender are a risk factor, none of them pre-determines the presence of future complications.

Below is a list of the most common complications and the correspondent percentage that may occur (as stated in the medical literature):

  • Dysphagia (difficulty in swallowing): 7.7%
  • Mortality: 0-1.1%
  • Postoperative Hematoma surgical site: 1.3%
  • New spinal cord lesion: 0.2-4%
  • Worsening of preexisting spinal cord lesion: 0.5-3.3%
  • Transient radicular deficit: 1.2-19%
  • Persistent radicular deficit: 0.4%
  • Carotid or vertebral artery lesion: <1%.
  • Recurrent nerve lesion: 0.2-4%. Permanent in 1.55% of cases.

The mechanisms by which this complication occurs can be due to pressure or stretching which originate neuroapraxia, and postoperative edema. Injury to the recurrent laryngeal nerve can cause hoarseness or loss of voice, voice fatigue, cough, and aspiration. Other complications and their percentage are the following below:

  • Esophagus perforation: 0.25-1%
  • Postoperative Infection: 0.1-3%
  • Discitis: 0.2-1.9%
  • Meningitis. Very rare.
  • Neumothorax. Very rare.
  • Epidural Absces: 0.5-2%.


Dr. Vicenç Gilete, MD, Neurosurgeon & Spine Surgeon.

Neurosurgery volumes I–III. Edited by Robert H. Wilkins and Setti S. Rengachary. McGraw-Hill.

Handbook of Neurosurgery. Mark S.Greenberg, Seventh Edition. Thieme.

Last Update 2020-05-06 13:07:28

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