ACDF Surgery in Dubai (Anterior Cervical Discectomy and Fusion)
Who you'll see
Dr Sherief Elsayed
Consultant Spinal Surgeon, FRCS (Tr & Orth), UK-trained
Medically reviewed by Dr Sherief Elsayed, UK-trained Consultant Spinal Surgeon, FRCS (Tr & Orth). Last reviewed 15 October 2026.
Anterior cervical discectomy and fusion (ACDF) is a type of cervical fusion surgery. A worn or slipped neck disc is removed through a small cut at the front of the neck to take pressure off a trapped nerve or the spinal cord, and the two vertebrae on either side are then helped to grow together. This page explains who it helps, what happens on the day, recovery, risks and the evidence; Dr Sherief Elsayed performs ACDF in Dubai, as well as cervical disc replacement.
At a glance
- ACDF is offered for arm pain from a trapped nerve in the neck that has not settled, or for pressure on the spinal cord (myelopathy). Most trapped nerves settle without an operation: in a population study, 26% had surgery over about 5 years (Radhakrishnan et al., 1994).
- In a randomised trial of 59 people with a trapped nerve, 93% of those who had ACDF with physiotherapy rated themselves better or much better 5 to 8 years later, against 62% after physiotherapy alone (Engquist et al., 2017).
- Swallowing difficulty is common at first: 50% of people at 1 month, falling to 12.5% at 12 months, and moderate or severe in 4.8% at 6 months (Bazaz et al., 2002).
- Most people stay one night in hospital and return to desk work and driving after about 2 weeks.
What is ACDF?
The neck (cervical spine) has seven vertebrae, with a cushioning disc between each pair. A disc can bulge or split (a disc prolapse), and the vertebrae can grow bony spurs (osteophytes); either can press on a nerve root or on the spinal cord.
The name describes the operation:
- Anterior cervical: the neck is approached from the front. The disc lies in front of the spinal cord, so it can be removed without moving the cord.
- Discectomy: the disc, and any bone spurs, are removed to free the nerve or cord.
- Fusion: the empty space is filled with a spacer (a cage) packed with bone graft or a bone substitute. Over the following months new bone grows through it, and the two vertebrae join into one solid block.
The cage may be held with a small metal plate and screws on the front of the spine, or it may be a stand-alone (zero-profile) cage with built-in screws or anchors. Dr Elsayed’s choice depends mainly on the number of levels treated. ACDF can treat one level or several levels in the same operation.
Who ACDF is for
ACDF treats pressure on a nerve root or the spinal cord in the neck when your symptoms, your examination and your MRI scan all point to the same level.
A trapped nerve causing arm pain (cervical radiculopathy)
A trapped nerve causes pain spreading from the neck into the shoulder blade, arm or hand, often with pins and needles, numbness or weakness. Most episodes improve with time and non-surgical care: in the population study, 90% were free of symptoms or only mildly affected at follow-up (Radhakrishnan et al., 1994). ACDF is considered when:
- arm pain remains severe or disabling despite several weeks of non-surgical treatment;
- weakness in the arm or hand is significant or getting worse; or
- the problem keeps returning and affecting work or sleep.
More on cervical radiculopathy and on other causes of arm pain.
Pressure on the spinal cord (cervical myelopathy)
When a disc or bone spur narrows the spinal canal, it can squeeze the spinal cord. Typical signs are clumsy or numb hands, difficulty with buttons or writing, unsteady walking and poor balance. An international guideline recommends surgery for moderate and severe myelopathy. For mild myelopathy it suggests either surgery or a supervised trial of structured rehabilitation, with surgery if symptoms get worse (Fehlings et al., 2017). The main aim of surgery is to stop further damage to the cord; how much lost function returns varies from person to person. More on cervical myelopathy.
Slippage or instability
When a vertebra has slipped or moves abnormally, fusion holds the level still as well as freeing the nerves.
When ACDF may not be the right operation
- Neck pain on its own, without a trapped nerve or spinal cord compression, is not usually a reason for ACDF.
- Pressure mainly behind the spinal cord, or along many levels, for example from a thickened ligament, may be better treated by an operation from the back of the neck. These operations are described on cervical spine surgeries.
- One or two levels in an otherwise healthy neck, with good bone, healthy facet joints (the small joints at the back of the neck) and a disc that still moves, may suit cervical disc replacement, which keeps that level moving.
- A single trapped nerve from a disc fragment or bone spur off to one side can sometimes be freed through keyhole surgery from the back of the neck (posterior cervical foraminotomy), without a fusion. Dr Elsayed does not perform this operation; if it would suit you, he refers you to a colleague who does.
Some conditions need extra planning rather than ruling ACDF out: smoking, diabetes, thin bones (osteoporosis), previous surgery or radiotherapy at the front of the neck, and an existing voice problem.
Assessment and tests
Dr Elsayed will examine the strength, reflexes and feeling in your arms and legs, and your hand function and walking. Tests may include:
- MRI scan: shows the discs, nerves and spinal cord, and is usually essential.
- X-rays, including views taken bending forwards and backwards, to check alignment and abnormal movement.
- CT scan: shows bone spurs clearly, and bone forming in the ligament behind the vertebrae (ossification of the posterior longitudinal ligament, or OPLL).
- Nerve conduction studies: when symptoms could come from a nerve trapped in the arm instead, such as at the wrist.
More on preparing for surgery.
What happens on the day
Dr Elsayed performs ACDF at American Hospital Dubai (Oud Metha and Dubai Science Park) and Emirates Hospital Jumeirah.
- Before: you meet the anaesthetist and sign a consent form once the risks and alternatives have been explained again.
- Anaesthetic: you are fully asleep under a general anaesthetic, lying on your back.
- Approach: a short cut is made in a skin crease at the front of the neck, and the windpipe and gullet are gently moved aside. An X-ray confirms the level.
- Decompression: the disc and any bone spurs are removed under magnification, and the nerve root or spinal cord is freed.
- Fusion: the cage, filled with graft, is placed in the disc space and secured. X-rays check its position.
- Closing: the wound is closed with stitches under the skin.
Recovery after ACDF
- Hospital stay: usually one night.
- The first weeks: a sore throat, some difficulty swallowing and an ache in the neck or between the shoulder blades are expected; soft food helps. Walk every day.
- Your symptoms: arm pain often eases early. Numbness and weakness can take weeks to months to improve, and long-standing nerve damage may not fully recover.
- Collar: not needed after ACDF for a worn or slipped disc. A collar is used only when the operation follows an injury (trauma).
- Work: desk work is usually possible after about 2 weeks; when to return to manual work and lifting is decided at your consultation. In one US trial, 39% of people were back at work 6 weeks after single-level ACDF (Badve et al., 2020).
- Driving: usually after about 2 weeks, once you can turn your head freely to check over your shoulder and are not taking painkillers that make you drowsy.
- Bone healing: the vertebrae fuse gradually over the following months, and X-rays at follow-up check progress. Smoking slows healing: in an older study of multi-level fusion without plates, all levels fused in 50% of smokers against 76% of non-smokers, and smokers also had worse clinical results (Hilibrand et al., 2001). Stopping before surgery helps.
- Physiotherapy and follow-up: decided at your consultation. More on post-operative care.
Risks of ACDF
In a series of 1,015 first-time ACDF operations, about 1 in 5 patients (19.3%) had a complication of some kind, most often swallowing difficulty, a collection of blood or a hoarse voice, and nearly all were managed successfully (Fountas et al., 2007). These figures come from published studies; your own risks depend on your health and the number of levels.
Common
- Swallowing difficulty, usually mild and improving over weeks to months: reported by 50% at 1 month, 32% at 2 months, 18% at 6 months and 12.5% at 12 months, with moderate or severe difficulty in 4.8% at 6 months. Surgery at several levels, and being female, raised the risk (Bazaz et al., 2002).
- Sore throat and neck ache in the first days and weeks.
Uncommon
- Hoarse or weak voice, from irritation of the nerve to the voice box (the recurrent laryngeal nerve): 3.1% in the series of 1,015 operations (Fountas et al., 2007). It is usually temporary; weakness of a vocal cord remained at 12 months in 1.3% in another study (Bazaz et al., 2002).
- Bleeding into the neck (haematoma): a collection of blood occurred in 5.6%, and 2.4% needed a return to the operating theatre to remove it (Fountas et al., 2007). It is urgent because swelling can press on the windpipe.
- Non-union (pseudarthrosis), when the bones do not fuse: symptomatic in about 3% to 4% of patients in pooled studies of the first few years, with higher figures inside disc replacement trials (Wadhwa et al., 2026). The risk rises with the number of levels: in pooled older studies of ACDF with a plate, the bones fused in 97.1% after one level, 94.6% after two and 82.5% after three (Fraser and Härtl, 2007). Not every non-union causes symptoms, but some need further surgery.
- Implant problems: the cage sinking into the bone, or a screw loosening.
- Incomplete relief of pain, numbness or weakness.
Rare but serious
From the same series of 1,015 operations (Fountas et al., 2007):
- a tear in the lining around the spinal cord, which can leak spinal fluid (dural tear): 0.5%;
- injury to the gullet (oesophageal perforation): 0.3%;
- worsening of spinal cord symptoms: 0.2%;
- Horner’s syndrome, a drooping eyelid and small pupil on one side from irritation of nerves beside the spine: 0.1%;
- wound infection: 0.1%;
- death: 1 patient in 1,015 (0.1%), after an injury to the gullet.
Injury to a nerve root, the spinal cord, a major blood vessel or the windpipe is also possible, but rare.
Longer term: wear at the neighbouring discs
Adjacent segment disease is new wear at the disc above or below a fusion, causing fresh arm pain or cord compression. In a long-term study of 374 patients, it appeared at about 2.9% per year, an estimated 25.6% (about 1 in 4) within 10 years, and over two-thirds of those affected needed another operation. The risk was lower after multi-level than single-level fusion, and the authors concluded that their findings pointed to ongoing natural wear (spondylosis) as the cause (Hilibrand et al., 1999).
What to expect: the evidence in plain terms
- Pain and function: in the randomised trial above, both groups improved, but ACDF with physiotherapy reduced neck disability and neck pain more than physiotherapy alone at 5 to 8 years. The difference in arm pain was not statistically significant (Engquist et al., 2017).
- Nerve function: improved or stayed stable in 89% of patients 7 years after single-level ACDF in a US trial (Janssen et al., 2015).
- Further surgery: in a disc replacement trial, 18% of ACDF patients had further surgery within 7 years (Janssen et al., 2015). Outside these trials it is reported less often: across 61 studies, repeat surgery after ACDF at mid-term follow-up was 12% inside disc replacement trials against 3% in other studies (Wadhwa et al., 2026).
ACDF or cervical disc replacement?
Cervical disc replacement removes the disc in the same way, but fits an artificial disc that keeps the level moving. It suits fewer necks: usually one or two levels, with healthy facet joints, good bone and some movement left. For people who suit both, long-term studies show similar relief and fewer repeat operations after disc replacement (Quinto et al., 2024). The two are compared side by side, with the limits of the evidence, on ACDF or cervical disc replacement?
Alternatives to ACDF
- Non-surgical treatment: time, pain relief, physiotherapy and staying active. Most trapped nerves settle this way, and people treated with physiotherapy alone also improved in the randomised trial. An injection around the trapped nerve is sometimes considered.
- Cervical disc replacement, for suitable necks (see above).
- Posterior cervical foraminotomy, for a single trapped nerve off to one side; Dr Elsayed refers you to a colleague for this.
- Operations from the back of the neck, such as laminectomy and fusion, when the pressure lies behind the cord or along many levels.
Symptoms that need urgent care
After neck surgery, call 998 (UAE ambulance) or go to the nearest emergency department straight away if you have:
- swelling in the neck that is getting bigger, with difficulty breathing, noisy breathing, or difficulty swallowing your saliva;
- new or rapidly worsening weakness or numbness in your arms or legs, difficulty walking, or loss of bladder or bowel control.
Contact Dr Elsayed’s team the same day, or go to an emergency department, for fever; redness, swelling or discharge from the wound; swallowing that is getting worse rather than better, especially with fever or chest pain; or clear fluid leaking from the wound.
Before surgery, if you have spinal cord compression, get help quickly if your hands become clumsier, your walking or balance gets worse, or weakness spreads. If this comes on suddenly or affects your bladder or bowels, call 998.
Table of Contents
Your consultation with Dr Sherief Elsayed
Dr Sherief Elsayed is a UK-trained Consultant Spinal Surgeon, FRCS (Tr & Orth), whose clinical work covers complex and revision spinal surgery, deformity, minimally invasive surgery and endoscopy. He performs both ACDF and cervical disc replacement, so the advice you receive is not limited to one operation. He will examine you, review your MRI or arrange one, and explain whether non-surgical treatment, ACDF or another operation suits your neck. You can take time to decide or seek another opinion.
He sees patients at OrthoPro Clinic, Dubai Science Park, and at UPANDRUNNING on Al Wasl Road, and operates at American Hospital Dubai (Oud Metha and Dubai Science Park) and Emirates Hospital Jumeirah. To book, call OrthoPro Clinic on 04 835 9000, send a WhatsApp message to 052 105 2798, or use the contact page. Please bring your MRI images and reports. Fees depend on the procedure and your insurance. Most major insurance accepted. Please check with reception.
Frequently asked questions
Anterior cervical discectomy and fusion: the disc is removed from the front of the neck, and the two vertebrae are then joined.
Not usually. Dr Elsayed uses a collar only when ACDF follows an injury (trauma). Practice varies between surgeons, so you may read different advice elsewhere.
The vertebrae fuse gradually over the following months as new bone grows through the cage. X-rays at follow-up check progress. Smoking slows bone healing, so stopping helps (Hilibrand et al., 2001).
Desk work and driving are usually possible after about 2 weeks, once you can turn your head freely and are not taking painkillers that make you drowsy. When to return to manual work and lifting is decided at your consultation.
The neck usually feels stiff and sore at first, and this eases as it heals. Each fused level no longer moves, so stiffness is more noticeable when several levels are fused.
Some people do. New wear at a neighbouring disc appeared at about 2.9% per year after anterior neck fusion in a long-term study, mainly from natural wear (Hilibrand et al., 1999). Repeat surgery rates vary widely between studies, from 3% to 12% at mid-term follow-up (Wadhwa et al., 2026).
It depends on your whole neck: the number of levels, the facet joints, stability, bone quality and whether the disc still moves. Dr Elsayed performs both and will explain which suits you; see ACDF or cervical disc replacement?