Smith and Robinson describe the original technique for anterior cervical discectomy and interbody fusion (ACDF) and report outcomes in the first 14 patients treated, beginning in 1954. The central question: can anterior disc removal and iliac crest bone grafting fuse the cervical spine more safely and completely than posterior laminectomy for radiculopathy and myelopathy? This is the founding paper of modern ACDF.
Before this paper, surgeons treating cervical radiculopathy from spondylosis relied on posterior laminectomy and foraminotomy. Those approaches work for posterior cord compression but are unreliable for anterolateral osteophytes, and bilateral foraminotomy risks destabilizing the posterior column.
This paper established that the anterior approach allows direct access to the offending pathology, disc removal without entering the canal, and level-specific interbody fusion. The key insight still tested on boards: relief comes from eliminating segmental motion, not from distracting the foramen. The graft resorbs. Foraminal height does not increase long-term.
When counseling a patient before ACDF, this is why you tell them the procedure fuses the segment rather than "opens up" the foramen. The mechanism of benefit is motion elimination.
The anatomic principles described here remain operative today: left-sided approach to protect the recurrent laryngeal nerve, strict midline dissection to avoid the sympathetic trunk (Horner's), and the carotid tubercle of C6 as the key intraoperative landmark for level identification.
Smith and Robinson describe the original technique for anterior cervical discectomy and interbody fusion (ACDF) and report outcomes in the first 14 patients treated, beginning in 1954. The central question: can anterior disc removal and iliac crest bone grafting fuse the cervical spine more safely and completely than posterior laminectomy for radiculopathy and myelopathy? This is the founding paper of modern ACDF.
Before this paper, surgeons treating cervical radiculopathy from spondylosis relied on posterior laminectomy and foraminotomy. Those approaches work for posterior cord compression but are unreliable for anterolateral osteophytes, and bilateral foraminotomy risks destabilizing the posterior column.
This paper established that the anterior approach allows direct access to the offending pathology, disc removal without entering the canal, and level-specific interbody fusion. The key insight still tested on boards: relief comes from eliminating segmental motion, not from distracting the foramen. The graft resorbs. Foraminal height does not increase long-term.
When counseling a patient before ACDF, this is why you tell them the procedure fuses the segment rather than "opens up" the foramen. The mechanism of benefit is motion elimination.
The anatomic principles described here remain operative today: left-sided approach to protect the recurrent laryngeal nerve, strict midline dissection to avoid the sympathetic trunk (Horner's), and the carotid tubercle of C6 as the key intraoperative landmark for level identification.