Cervical Spine Surgery · Naples & Fort Myers, FL
ACDF — Cervical
Fusion Done Right
Anterior Cervical Discectomy and Fusion is the gold standard for cervical myelopathy, radiculopathy, and cervical stenosis. A lipstick-sized incision in the natural neck crease. No muscle disruption. Same-day or next-day discharge. Neuromonitoring on every case. Techniques that set this practice apart.
"ACDF is one of the most successful surgeries in all of spine care. Patients go home the same day, their arm pain resolves almost immediately, and most tell me the incision is barely visible within weeks."
Dr. G. Katsevman, MD · Neurosurgeon & Spine Surgeonin natural neck crease
no muscle cut
monitoring every case
minimize swallowing issues
for 360° fusion when needed
Indications
When is ACDF the right surgery?
ACDF is the most commonly performed cervical spine surgery — and one of the most successful. It removes the damaged or herniated cervical disc, decompresses the spinal cord or nerve roots causing your symptoms, and fuses the adjacent vertebrae with a cage and plate. It is the gold standard when the anatomy, severity, or patient factors make cervical disc replacement less appropriate.
Cervical Myelopathy
Compression of the spinal cord itself — causing progressive hand clumsiness, gait imbalance, weakness, and bowel or bladder changes. Myelopathy is the most urgent indication for ACDF. The cord cannot heal what it loses; early decompression before permanent deficit is the goal. When the cord is compressed, ACDF is almost always the surgery of choice over disc replacement.
Cervical Radiculopathy
A pinched nerve root in the neck causing shooting arm pain, numbness, tingling, or weakness — the cervical equivalent of sciatica. When conservative treatment (physical therapy, injections) has failed and the MRI confirms the level, ACDF relieves the compression with a very high success rate. Arm pain often resolves within days of surgery.
Cervical Stenosis
Narrowing of the cervical spinal canal from disc degeneration, bone spurs, or ligament thickening that compresses the cord or roots. ACDF removes the offending disc and bone, widens the canal from the front, and stabilizes the segment — arresting the progression that stenosis would cause if left untreated.
Multi-Level Disease
When two, three, or more cervical levels are involved, ACDF addresses all affected levels in a single surgery. Dr. Katsevman performs each level as an individual interbody fusion — a technique that reduces swallowing complications compared to the large plate constructs used in some multi-level approaches.
When Disc Replacement Is Not Appropriate
Patients with significant facet arthritis, instability, osteoporosis, active infection, or prior cervical surgery may not be suitable candidates for disc replacement. ACDF provides reliable, proven stability for patients who need fusion rather than motion preservation. Dr. Katsevman performs both and selects the right approach for each patient.
Significant Disc Herniation with Cord Signal Change
When cervical MRI shows signal change within the spinal cord itself (myelomalacia), the window for meaningful neurological recovery is limited. ACDF provides direct anterior decompression of the cord at the site of compression — stopping the damage and allowing the best possible recovery of function.
The procedure
How ACDF works
ACDF is performed through the front of the neck in under two hours for most cases. No muscles are cut. The incision is hidden in a natural skin crease. Patients walk the same day and go home the same day or the next morning.
A lipstick-sized incision in the neck crease
Under general anesthesia, Dr. Katsevman makes a single small incision — roughly the size of a lipstick mark — in the natural horizontal crease of the neck. The approach to the spine is anterior (from the front), passing between the structures of the neck rather than through them.
No muscles are cut. The strap muscles of the neck are gently retracted rather than divided, and the carotid sheath and esophagus are moved aside to expose the front of the cervical spine. This is why post-operative pain is so mild compared to posterior approaches — there is essentially no muscle injury to recover from. Most patients describe the incision as completely invisible within a few weeks.
Throughout the procedure, continuous intraoperative neuromonitoring (IOM) tracks the electrical signals in the spinal cord and nerve roots in real time. Any change in these signals alerts Dr. Katsevman immediately, providing an extra layer of safety that not all cervical surgeons use.
Remove the disc, decompress the cord and roots
The damaged cervical disc is completely removed under microscope magnification. Any herniated fragments, bone spurs, or thickened posterior longitudinal ligament compressing the spinal cord or nerve roots are carefully removed.
This is the decompression step — the moment the pressure on the cord or nerve is relieved. For radiculopathy patients, arm pain often begins improving before they leave the recovery room. For myelopathy patients, the decompression prevents further neurological decline and allows the best possible recovery.
For multi-level ACDF, Dr. Katsevman addresses each level individually as a separate interbody fusion rather than using a single long anterior plate spanning multiple levels. This technique limits the soft tissue retraction required at any one time, significantly reducing the risk of post-operative dysphagia (swallowing difficulty) — one of the most common and frustrating complications of multi-level cervical surgery.
Place the fusion cage — restore height and stability
A precision interbody cage — packed with bone graft material to promote fusion — is placed into the prepared disc space, restoring disc height, opening the foramen, and providing immediate structural stability. A low-profile anterior plate and screws are then fixed to the vertebrae above and below to hold the construct while bone fusion occurs over the following weeks to months.
Steroid injection — protecting your swallowing
At the conclusion of every ACDF, Dr. Katsevman injects a small dose of corticosteroid into the prevertebral soft tissues before closing. This is a targeted anti-inflammatory measure that reduces post-operative swelling in the tissue surrounding the esophagus — the primary cause of the swallowing difficulty (dysphagia) that many ACDF patients experience in the days after surgery.
Not all surgeons perform this step — Dr. Katsevman does it routinely. The result is a meaningfully better swallowing experience in the post-operative period, less discomfort with eating and drinking, and reduced patient anxiety about a complication that can be significantly distressing even when it is temporary.
What sets this practice apart
Not all ACDF is performed the same way
ACDF is a standardized procedure. But the technical decisions made before, during, and after the surgery determine the patient experience and the quality of the outcome.
Continuous intraoperative neuromonitoring (IOM) tracks real-time electrophysiological signals from the spinal cord and nerve roots throughout surgery. Any change — before it becomes visible or causes a problem — triggers an immediate alert. Not all cervical surgeons use neuromonitoring. Dr. Katsevman uses it on every ACDF case as a non-negotiable safety standard. The cost to the patient is zero; the safety margin it provides is significant.
Dysphagia (difficulty swallowing) after ACDF is common — reported in up to 50% of patients to some degree in the early post-operative period. It results from retraction-related swelling of the prevertebral soft tissues. Dr. Katsevman injects corticosteroid into the prevertebral space at the end of every case to reduce this swelling before the patient wakes up. This simple, evidence-supported step meaningfully improves the post-operative swallowing experience and is not universally practiced.
For two- or three-level ACDF, some surgeons use a single long anterior plate spanning all levels simultaneously — maximizing efficiency but increasing the retraction duration and, with it, swallowing risk. Dr. Katsevman performs each level as an individual interbody fusion, completing and releasing one level before moving to the next. This staged-level approach limits sustained soft tissue retraction and further reduces the dysphagia risk in multi-level cases.
Pseudoarthrosis (failure of the fusion to form solid bone) is a known ACDF risk — higher in smokers, diabetics, osteoporotic patients, those on long-term steroids, and multi-level cases. When a patient is at elevated risk, some surgeons recommend a large open posterior cervical fusion — a major second surgery involving extensive dissection of the posterior neck muscles to place lateral mass or pedicle screws and rods.
Dr. Katsevman offers a fundamentally different approach: Corus® posterior cervical facet cages — small titanium implants placed through the facet joints from the back of the neck through incisions the size of a quarter. Up to 4 levels can be treated through a single small posterior incision, providing 360° stability (anterior ACDF + posterior Corus) without any large posterior neck dissection, muscle stripping, or significant additional pain.
This is a technique performed by only a select few surgeons nationally. For the right patient — those at real risk of nonunion who would otherwise face either a failed fusion or a large open posterior surgery — Corus changes the calculus entirely. The security of a 360° construct. A fraction of the morbidity.
Before deciding on ACDF
Is cervical disc replacement an option for you?
For the right patient, cervical disc replacement (ACDA) preserves motion, protects adjacent levels, and avoids the permanence of fusion entirely. Dr. Katsevman performs both and will recommend whichever is more appropriate for your specific anatomy, diagnosis, and goals.
Simplify® & ProDisc-C® Preserves motion at the treated level. Protects adjacent discs. 4× fewer reoperations at 7 years vs. fusion. No collar. No restrictions at 6 weeks. FDA-approved for 1–2 levels. Dr. K on surgeon locator for both devices. Learn more → Read the blog Understanding Cervical Disc Replacement
ACDA vs. ACDF explained Dr. Katsevman’s complete patient guide to cervical disc replacement — when it is and isn’t appropriate, what the devices are, and what to expect. Read the article →
Learn more
From Dr. Katsevman’s blog
Common questions
What patients ask most
What is ACDF and how long does surgery take? +
ACDF stands for Anterior Cervical Discectomy and Fusion. The surgeon approaches the cervical spine from the front of the neck, removes the damaged disc, decompresses the spinal cord or nerve roots, and places an interbody cage and plate to fuse the adjacent vertebrae. For a single-level ACDF, surgery typically takes 60–90 minutes. Two-level ACDF runs approximately 2–2.5 hours. Three-level cases are longer depending on complexity. Most patients go home the same day or the following morning.
Will I have trouble swallowing after ACDF? +
Some degree of swallowing difficulty (dysphagia) is one of the most common side effects of ACDF — reported in up to 50% of patients at some point in the early recovery period. It results from retraction-related swelling of the soft tissues around the esophagus during surgery. In most patients it is mild and resolves within days to weeks. Dr. Katsevman takes two specific steps to minimize this: he performs multi-level ACDF one level at a time (rather than using a single long spanning plate) to limit retraction duration, and he injects corticosteroid into the prevertebral soft tissue at the end of every case to reduce post-operative swelling before the patient wakes up. These measures meaningfully reduce the severity and duration of swallowing difficulty.
What is neuromonitoring and why does Dr. Katsevman use it? +
Intraoperative neuromonitoring (IOM) uses small electrodes to continuously track the electrical signals travelling through the spinal cord and nerve roots during surgery. A dedicated neuromonitoring technologist monitors the waveforms in real time and alerts Dr. Katsevman immediately if any signal changes. This provides an early warning system for potential nerve or cord injury — before any damage becomes permanent. Not all cervical surgeons use neuromonitoring. Dr. Katsevman uses it on every ACDF as a non-negotiable safety standard, particularly important given the proximity of the surgery to the spinal cord.
What is pseudoarthrosis and am I at risk? +
Pseudoarthrosis is a failure of the fusion to form solid bone — the two vertebrae do not grow together as intended. It occurs in a small percentage of ACDF patients but is more common in smokers, diabetics, patients on long-term steroids or osteoporosis medications, those undergoing multi-level fusion, and revision cases. When Dr. Katsevman identifies a patient as being at elevated risk, he offers minimally invasive posterior cervical fixation — small percutaneous screws placed through tiny incisions in the back of the neck that supplement the anterior construct and provide 360-degree stability, dramatically reducing pseudoarthrosis risk without the morbidity of open posterior surgery. This avoids the large posterior incision and extensive muscle dissection that some surgeons use for the same purpose.
Should I have ACDF or cervical disc replacement? +
This is the most important question in cervical spine surgery — and the answer depends on your specific anatomy, diagnosis, and goals. Disc replacement (ACDA) is preferable when the patient has radiculopathy or mild myelopathy, adequate facet joints, no significant instability, and no contraindications to motion preservation. It preserves motion, protects adjacent levels, and has 4× fewer reoperations at 7 years vs. fusion. ACDF is preferable when myelopathy is moderate to severe, facet arthritis is significant, instability is present, or the patient has anatomy that makes disc replacement technically unsuitable. Dr. Katsevman performs both. He will review your imaging and make a clear recommendation with a full explanation at your consultation.
Will I need to wear a collar after ACDF? +
A soft cervical collar is sometimes recommended for comfort in the early post-operative period — typically 2–4 weeks — to limit neck motion while the fusion heals and to reduce muscle spasm. Whether a collar is recommended, how long, and what type depends on the number of levels fused, the fixation used, and individual patient factors. Dr. Katsevman will provide specific post-operative instructions at your consultation and after surgery. Most single-level ACDF patients find collar use decreases quickly as comfort improves.
"ACDF is already one of the most successful surgeries in medicine. My job is to add the details that make it even better — neuromonitoring, prevertebral steroids, level-by-level technique, and a posterior option for patients who need more security."
Gennadiy (Gene) A. Katsevman, MD
Neurosurgeon & Minimally Invasive Spine Surgeon
Fellowship-trained at Barrow Neurological Institute — one of the world’s premier centers for cervical spine surgery
Neurosurgery residency, West Virginia University — Level 1 Trauma Center
Performs ACDF and cervical disc replacement — approach selected per patient anatomy and goals
Neuromonitoring on every ACDF case; prevertebral steroid injection routinely performed
Multi-level ACDF performed level by level to minimize dysphagia risk
Corus® posterior cervical facet cages — MIS 360° fusion for pseudoarthrosis-risk patients; performed by only a select few surgeons nationally
Listed on surgeon locator: Simplify® Cervical Disc (Globus Medical) & ProDisc-C® (Centinel Spine)
30+ peer-reviewed publications in spine surgery and neurosurgery
Naples Top Doctor in Neurosurgery — 2024, 2025, and 2026
5-star Google rating · Healthgrades Choice Provider · WebMD Preferred Provider
Take the next step
Neck pain. Arm pain. Myelopathy.
Let’s find the right answer.
Schedule a consultation with Dr. Katsevman in Naples or Fort Myers — or via telemedicine — to review your imaging and determine whether ACDF, disc replacement, or another approach is right for you.
6101 Pine Ridge Road #101
Naples, FL 34119
Fort Myers, FL 33919
Available statewide & nationwide