ACDF Surgery in Turkey

Anterior cervical fusion (ACDF, short for Anterior Cervical Discectomy and Fusion) is a surgical operation performed through the front of the neck. The damaged disc is removed, and a bone graft or cage is placed in its space to help the two neighboring vertebrae fuse together.

This surgery is usually considered when a disc or bone spurs press on a nerve root or on the spinal cord, causing neurological symptoms such as arm pain, numbness, or weakness, and imaging confirms the pressure. Neck pain alone is not usually a strong reason for this decision.

Recovery takes time after surgery. For a while, the patient may have neck pain, difficulty swallowing solid food, and a hoarse voice. The bone then needs months to fuse.

Many cases are treated without surgery first. Whether the procedure suits you is decided by the surgeon after a clinical examination and imaging.

• ACDF removes a cervical disc from the front and fuses the two adjacent vertebrae.
• The main reason for it is neurological symptoms explained by pressure, confirmed on imaging, on a nerve root or the spinal cord, not neck pain alone.
• It does not suit everyone with neck complaints, and many people are treated without surgery first.
• Do not ignore symptoms such as clumsy hands or trouble walking, even if neck pain is not severe.
• The front (anterior) approach has its own risks: swallowing and voice problems, bleeding, infection, nonunion, and adjacent segment disease.
• The evidence comparing ACDF with alternatives is mixed, and some questions remain debated.
• Eligibility is decided after clinical evaluation and imaging.

What Is Anterior Cervical Fusion (ACDF)?

The surgeon reaches the cervical spine through the front of the neck. According to Cleveland Clinic, the soft tissues, including the windpipe (trachea) and the esophagus, are gently moved aside to expose the affected disc.

The disc and any bone spurs pressing on the nerve or spinal cord are then removed. A bone graft or cage is placed in the space the disc occupied. AAOS and Cleveland Clinic note that the surgeon often adds a plate and screws, though, as discussed below, this varies between surgeons.

“Cervical” here refers to the neck, not the cervix.

Fusion means the two vertebrae gradually become one bone. Cleveland Clinic states that motion is lost only between the fused vertebrae, and that many patients do not notice a major change in neck flexibility.

Why Is Anterior Cervical Fusion Done?

The reasons relate to neurological symptoms explained by pressure, confirmed on imaging, on a nerve root or the spinal cord. The picture differs between radiculopathy (a pinched nerve root) and myelopathy (pressure on the spinal cord itself), and what is true for one should not be generalized to the other.

AANS states that the surgeon checks that imaging findings match the symptoms. It also states that surgery is considered when conservative treatment does not work, or when neurological symptoms are getting worse, such as weakness or difficulty with balance and walking.

Cervical Radiculopathy

This occurs when something presses on one of the nerve roots leaving the spinal cord in the neck. It causes pain that spreads to the shoulder or arm, sometimes with numbness or weakness. The pressure often comes from a herniated disc or bone spurs. We explain these in our articles on herniated disc treatment and spinal stenosis treatment.

AAOS states that surgery is considered when symptoms persist or worsen despite non-surgical treatment. Cleveland Clinic says that having symptoms does not necessarily mean surgery is needed.

A 2010 Cochrane review, now dated, included only two small trials with risk of bias. One found surgery gave better short-term symptom relief than physical therapy or a collar, with no clear difference after one year. In the other (mild myelopathy), there was no difference between surgery and conservative treatment after three years. The review concluded that the evidence was of low quality and insufficient to settle the balance of benefits and risks. This does not mean surgery is ineffective. It means the evidence analyzed was limited.

Cervical Myelopathy

This occurs when degenerative wear in the neck presses on the spinal cord itself. The Cochrane review defines it as stiffness and weakness in the legs, with or without numbness and clumsiness in the hands. AANS lists difficulty with balance and walking among its signs. Johns Hopkins notes that some patients have no neck pain at all.

Sources differ in tone on timing:

• Johns Hopkins considers surgery often necessary and says earlier diagnosis is associated with more successful treatment.
• The 2017 AOSpine/CSRS guideline recommends surgery for moderate and severe myelopathy. For mild disease, it suggests either surgery or a supervised rehabilitation program with close monitoring, with surgery if neurological deterioration occurs.
• For people whose scans show cord compression but who have no signs or symptoms of radiculopathy, the guideline suggests clinical follow-up and education about the signs of myelopathy. Those who have radiculopathy with cord compression should be told that their risk of developing myelopathy is higher.

This guideline addresses surgery for degenerative cervical myelopathy in general. It does not limit its recommendation to ACDF or compare surgical approaches, and it dates from 2017.

AAOS describes the goal of surgery here as first stabilizing the condition and preventing deterioration, then improving symptoms. It notes that results vary: some patients improve, some stay the same, and some get worse despite surgery. Function may not return to normal. It also states that studies have not shown one surgical approach to be superior to another, and that the choice depends on the patient’s situation.

Neck Pain Alone

According to the open sources, isolated neck pain is not usually a strong reason for surgery:

• NHS says surgery is considered when a nerve is pinched or there is a spinal cord problem.
• AANS notes that mild stenosis can be treated conservatively as long as the symptoms are limited to neck pain.
• An older systematic review (Riew and colleagues, 2010) found no studies comparing ACDF with non-surgical treatment for neck pain without radiculopathy or myelopathy, and low-level evidence of some improvement in case series.
• However, Cleveland Clinic lists “severe neck pain” among symptoms that may lead to consideration of surgery after non-surgical treatment fails.

A 2020 meta-analysis found that accompanying neck pain usually improves after ACDF in people operated on for radiculopathy or myelopathy. This does not make surgery a treatment for isolated neck pain.

None of this means ignoring your symptoms. If you develop numbness, weakness, clumsy hands, or trouble walking, see a doctor even if your neck pain is mild.

Symptoms That Need Urgent Assessment Before Surgery

NHS distinguishes between two levels in its page on cervical spondylosis:

• Heaviness or weakness in the arms or legs: needs urgent medical assessment.
• New problems walking, or loss of bladder or bowel control: call emergency services.

Am I a Suitable Candidate?

There is no general answer. The best that can be said from the open sources:

• Symptoms and imaging: Ask the surgeon how they interpret your imaging in relation to your symptoms. Wear and tear on a scan does not by itself mean you need surgery.
• Conservative treatment: The sources place surgery after non-surgical treatment in many cases of radiculopathy. Myelopathy may need faster assessment depending on severity and any deterioration.
• Smoking: In a meta-analysis (Nunna and colleagues, 2022), smoking was associated with a higher risk of nonunion after spinal fusion in general. This included the neck and lower back, with no distinction by location, number of levels, or graft material.
• General health: AAOS states on its myelopathy page that the risk of complications is higher in older adults, smokers, people with diabetes, and those with other medical conditions.
• Individual decision: The open sources did not list absolute contraindications to ACDF, so the judgment in each case rests with the surgeon.

How Is the Operation Done?

In general, according to AAOS and Cleveland Clinic:

1. A small incision is made at the front of the neck to reach the spine, with the soft tissues moved aside.
2. The disc and any bone spurs pressing on the nerve root or spinal cord are removed.
3. A bone graft or cage is placed where the disc was, so bone can fuse across it.
4. In many cases, a plate and screws are used to hold the area in place.

The plate in particular is a point of disagreement. AAOS states that plates increase the fusion rate. But a systematic review (Jain and colleagues, 2020) notes that use without a plate is common in some countries, and that there are no high-quality studies comparing the two approaches with modern implants. So a plate may or may not be added, depending on the surgeon’s judgment and the patient’s condition.

The number of levels treated varies from patient to patient, which changes the complexity of the surgery and some of its risks.

Fusion Materials

According to AAOS and Cleveland Clinic, the graft comes from one of these sources:

• Bone from the patient: usually taken from the hip through an extra incision, and it may cause pain at the harvest site (AAOS).
• Donor bone: supplied by a bone bank, according to Cleveland Clinic.
• A cage: AAOS describes it as a metal cage containing bone material. The Jain review notes that cages made of a medical polymer called PEEK are widely used.

What does the research say? A systematic review (Jain and colleagues, 2020) found that the reported fusion rates were similar between structural donor-bone grafts (allograft) and PEEK cages. However:

• No randomized trials compared them directly.
• Definitions of fusion differed between studies.
• Some studies did not track reoperation, so the two types cannot be compared on it.
• Subsidence (sinking) of a structural graft is hard to assess on imaging.

In another systematic review (2024), the data comparing donor-bone grafts with cages augmented by osteobiologics were limited and insufficient to say that either approach is more favorable.

So ask your surgeon which material they chose for your case and why.

What Does the Evidence Say?

AAOS states that most patients achieve good results after surgery for radiculopathy. But the evidence should be read with caution:

• The available literature on complications of anterior cervical surgery is mostly retrospective studies and case reports (Yee and colleagues, 2020). That review covers anterior cervical surgery in general, not ACDF alone.
• The absence of a statistically significant difference between two approaches does not prove they are equivalent. It may mean the study was not large or long enough to detect a difference.
• Results vary with patient selection and surgeon experience.

Comparing ACDF with an artificial disc: Some meta-analyses lean relatively toward the artificial disc on some outcomes. But a systematic review and meta-analysis published in Cureus in 2025 noted high heterogeneity between studies, and that several trials involved commercial sponsors and were not blinded. Two trials within the analysis found no clear difference. So the evidence is mixed and unresolved.

Fusion versus discectomy alone: An older systematic review (2012), whose title refers to neck pain, concluded that it found no additional value from adding fusion techniques to anterior discectomy. This should not be generalized to all cases. “Do I need fusion at all?” remains a legitimate question for the surgeon.

What affects fusion healing? Smoking is associated with a higher risk of nonunion after spinal fusion in general (Nunna and colleagues, 2022). But the review by Yee and colleagues reported that the association was not consistent in the individual ACDF studies it included. This does not rule out a role for other factors, and it does not mean a non-smoker is immune.

Risks and Complications

Every surgery has risks. The front approach in the neck has its own, because the surgeon works next to the esophagus, windpipe, vocal cords and their nerves, and major blood vessels. Below is what AAOS, Cleveland Clinic, AANS, and the review by Yee and colleagues (2020) report.

Swallowing and Voice

AAOS describes difficulty swallowing solid food and a hoarse voice for a few weeks as normal after surgery. Cleveland Clinic notes that nerve damage may show up as arm weakness, a change in the voice, or a drooping eyelid. AANS points to possible injury to the vocal cords, esophagus, or windpipe, and notes that swallowing or speech disturbances may persist in some patients.

Reported rates of swallowing problems varied widely between studies. In prospective studies, a considerable share of symptoms persisted beyond three months, while in retrospective studies, which may under-record, they were much lower. So this should not be presented as a minor issue.

Bleeding and Hematoma

Cleveland Clinic lists bleeding among the risks. The review by Yee and colleagues states that a collection of blood in the neck can compress the airway quickly and require urgent intervention. It is relatively rare but among the most serious complications, and one reason for the urgent-care section below.

Infection

AAOS and Cleveland Clinic list infection among the risks. Its signs are described in the urgent-care section below.

Nonunion

This means the bone fails to fuse at the fused site (pseudarthrosis). AAOS and AANS list it among the risks. It may cause pain or sometimes require another operation. Smoking is linked to it, as noted above. Rates vary between studies depending on the definition, the material, and the number of levels.

Adjacent Segment Disease

After fusion, new symptoms may appear from wear in the vertebrae above or below the fused area. AAOS and Cleveland Clinic list it among surgical risks and among the reasons for later surgery.

Its cause is debated among researchers. According to the review by Kaye and Hilibrand (2017), some see it as part of the natural progression of neck degeneration, while others believe fusion changes spinal mechanics and speeds up wear. Reports vary depending on whether they count imaging-only cases, symptomatic cases, or cases needing surgery (Yee and colleagues). So it cannot be said that fusion prevents deterioration of adjacent vertebrae, nor that fusion alone is its cause.

Other Risks

The open sources also mention pain at the graft harvest site and problems with the plate or screws (AAOS), injury to arteries or leakage of the fluid around the spinal cord (AANS, which describes them as relatively rare), and the possibility that symptoms will not go away or that later surgery will be needed (Cleveland Clinic).

Recovery After Surgery

The recovery plan varies from surgeon to surgeon and case to case. According to AAOS and Cleveland Clinic:

• The hospital stay may be short, and many patients start walking early.
• Pain medication is used for a period, and a neck collar may be recommended in some cases.
• Strenuous activity and heavy lifting are discouraged for a period set by the surgeon, with motion and strengthening exercises introduced gradually with physical therapy when permitted.
• Many patients return to desk work sooner than others, and timing depends on the type of work and the surgeon’s decision.
• Bone fusion may take months, and AAOS cites a range of 6 to 12 months.

Do not let feeling better early be a reason to skip your surgeon’s instructions. The bone needs time even after symptoms improve.

When to Seek Urgent Medical Care After Surgery

This list is drawn from general sources, and your surgeon’s instructions take priority:

• Difficulty breathing, or rapidly increasing swelling at the front of the neck: call emergency services immediately. AAOS lists difficulty breathing among the risks, and the review by Yee and colleagues indicates that a hematoma can threaten the airway quickly.
• Severe difficulty swallowing, or swallowing that gets worse after improving (Cleveland Clinic).
• Continuous bleeding from the incision (Cleveland Clinic).
• Fever, chills, redness, swelling or drainage from the incision, or increasing pain (Cleveland Clinic, and AAOS on its myelopathy page).
• New or worsening weakness or numbness in the arms or legs (Cleveland Clinic).

Alternatives in Brief

• Non-surgical treatment first in many cases, as discussed above.
• Artificial disc: AAOS describes its results as promising and comparable in the short term, with long-term research continuing. The evidence is mixed, as we noted. For details, see our article on artificial disc replacement.
• Posterior approach for radiculopathy (posterior foraminotomy): AAOS states that it may not require fusion and that recovery is likely quicker, in its wording. It does not suit every case.
• Posterior approach in myelopathy: AAOS says studies have not shown the superiority of one approach over another. To compare the two approaches, see our article on posterior cervical fusion.

Follow-Up After Surgery and Travel

AANS states that X-rays are used after surgery to monitor the condition. So before deciding, ask about the follow-up and imaging plan after you return to your country, and who will carry it out.

The timing of air travel after surgery is a decision for the surgical team based on your condition. The open sources we reviewed do not specify a time frame, so we do not give a number of days here.

Cost of Anterior Cervical Fusion in Turkey

O9 Medical’s estimated cost for this procedure ranges from USD 5,000 to USD 13,000. This is a preliminary estimate, not a binding offer, and the final price is set after the case is assessed.

The range is wide because the cost is affected by general factors, including:

• The number of levels treated.
• The complexity of the case.
• The type of implant or fusion material.
• The length of the hospital stay.
• Tests and imaging.
• Physical therapy.
• The patient’s general condition.

We have not specified what the package includes, so ask explicitly what it covers and what it does not before any decision.

Anterior Cervical Fusion in Turkey: What You Need to Know Before You Travel

Some Arab patients choose to travel to Turkey for this surgery. This choice does not in itself show that the surgery suits your case. That decision is made by the surgeon after examination and imaging.

O9 Medical helps you understand your options, arrange communication with the medical facility, and obtain information. It does not guarantee any result and does not replace the surgeon’s assessment.

Before you travel:

• Prepare your X-ray and MRI reports and a summary of your previous treatment.
• Ask for a written explanation of why surgery was chosen and which levels will be treated.
• Ask about the fusion material and the follow-up plan after you return.
• In choosing a surgeon or center, rely on their specialty and experience in spine surgery, not on promises. You can read our page on spine surgery.

You can find a broader overview on our page about orthopedic and joint surgery in Turkey.

Questions to Ask Your Surgeon Before Deciding

• How many ACDF operations have you done for a case like mine, with the same number of levels?
• Why did you choose fusion for my case instead of the other alternatives?
• What fusion material do you propose, and why?
• What happens if the fusion does not heal?
• How are swallowing and voice complications managed if they appear?
• What is the follow-up and imaging plan after I return to my country?
• What signs call for emergency care, and where do I go during my stay?
• What does the package include, and what does it not include?

These questions carry no promise. They are meant to help you understand your treatment plan.

Medical note: this information is for general education. It does not replace consultation with a specialist doctor and is not a diagnosis or a prescription.