My doctor has recommended a fusion for me (my neck). After two years of rehab, my pain is better but the X-rays, CT scans, and MRIs show it's not stable. Now we are talking about all the different options. The surgeon prefers to use something called ACDF with bone graft and a metal plate. I'd like to get by without the metal. Is it possible?

Sometimes when there's bone or disc degeneration in the cervical spine (neck), fusion is needed to stabilize the area. Over the years, one procedure in particular has gained popularity because of its effectiveness: the anterior cervical discectomy and fusion (ACDF).

ACDF involves removal of the disc from between two vertebrae, a procedure called discectomy. Most surgeons use bone graft material to fill in the space left by the discectomy and then and a metal plate to hold the spine in place while the bone graft material fills in. The use of a metal plate and screws to hold it in place is called instrumentation.

Stiffness is the desired outcome of fusion in order to provide stability. Fusion rates have improved greatly with this surgical technique. Too much stiffness is a potential problem when using a metal plate system but there is general agreement that fusion without instrumentation is less effective than with instrumentation.

Some of the decision depends on the number of levels that need to be fused, the condition of the bone, and surgeon preference. Surgeon preference is often the result of training and experience. Surgeons recommend treatment based on patient history, clinical findings (pain intensity, neurologic symptoms), and level of function (independence in daily activities, level of disability, ability to perform work tasks).

Before making a decision of this nature, you might want to consult with a second surgeon for his or her opinion as well. It is a permanent procedure so you'll want to feel comfortable that the type of surgery is what you want and need.

Andre Tomasino, MD, et al. Bioabsorbable Instrumentation for Single-Level Cervical Degenerative Disc Disease: A Radiological and Clinical Outcome Study. In Journal of Neurosurgery: Spine. November 2009. Vol. 11. No. 5. Pp. 529-537.

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