Complex spine surgery · London
ACDF anterior cervical fusion, by a complex spine surgeon.
A day-defining operation for cervical radiculopathy and myelopathy, done by a consultant spinal surgeon with a high-volume anterior practice, in a hospital with cervical disc replacement, laminoplasty and neuromonitoring on the same team.
Why patients choose us
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A named complex spine surgeon, not a general list
A consultant spinal surgeon with a high-volume anterior cervical practice, operating in a unit that meets British Association of Spine Surgeons standards.
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The right operation for the pathology
ACDF is not always the answer. For younger single-level radiculopathy we discuss cervical disc replacement. For multi-level myelopathy with preserved lordosis, laminoplasty.
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Independent, and free
We are paid by no hospital, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private ACDF costs in London.
Indicative ranges across our partner hospitals. Send the MRI report and we quote firm figures across two or three consultants.
In short
A single-level ACDF in our London network: £20,000 to £32,000, home the next day.
| Procedure | Indicative range | Typical duration | Stay |
|---|---|---|---|
| Consultant assessment and MRI review | £300–£550 | 45–60 min | Same visit |
| Single-level ACDF (C5/6 or C6/7) | £20,000–£32,000 | 60–90 min | Overnight stay |
| Two-level ACDF | £28,000–£42,000 | 90–120 min | 1–2 nights |
| Three-level ACDF | £36,000–£52,000 | 120–150 min | 2 nights |
| Four-level ACDF or hybrid construct | £45,000–£65,000 | 150–210 min | 2–3 nights |
| Second-opinion review of MRI and prior notes | £250–£450 | 30 min | 48 hours |
Prices vary by hospital, by which consultant does the case, by implant choice (PEEK, titanium, allograft, 3D-printed, with or without BMP) and by the number of levels fused. We come back with a firm quote within one working day.
The problem
The right surgeon, the right operation, the right hospital.
A cervical MRI booked onto a generic spine list is a recipe for the default operation, not the best one for you. We stop that happening.
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Is ACDF even the right operation?
A single-level soft-disc radiculopathy in a 42-year-old might be better served by disc replacement. A multi-level myelopathy with preserved lordosis might be better served by laminoplasty.
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Worried about the risks?
Dysphagia, hoarseness, C5 palsy, non-union and adjacent-segment disease - quoted honestly, with a 24-hour contact plan, before you consent.
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Want it done in a specialist unit?
A named complex spine surgeon, a hospital with intra-operative neuromonitoring and consultant anaesthetist cover, and an MDT that can pivot to a different operation if needed.
The journey
From MRI to fusion X-ray - what happens, in order.
One team from first message through to your 3-month fusion X-ray - including the physiotherapy plan.
Phase 1 · Before your surgery
Concierge, off-stage for you
Phase 2 · On the day
Overnight at the hospital
Phase 3 · After
Concierge, back on
- 01
Before
You send us the MRI and the story
A short, confidential form. Your symptoms, duration, prior physiotherapy or injections, and a link to the cervical MRI report.
- 02
Before
We come back with a recommendation
Within one working day: whether ACDF fits, or whether disc replacement, laminoplasty or non-operative care is the better call. Indicative price. An honest read either way.
- 03
Before
We arrange the surgery
Usually within two to four weeks. Flexion/extension X-rays and, where opsification is suspected, a CT are booked. Anticoagulants are reviewed with the team.
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On the day
Admission and anaesthetic
Same-day admission, consent and a chat with the surgeon and anaesthetist. General anaesthetic, supine with a small shoulder roll.
- 05
On the day
The ACDF itself
60 to 120 minutes. Smith-Robinson transverse crease incision, discectomy, posterior longitudinal ligament release, interbody cage and anterior plate. A soft drain for 24 hours.
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On the day
Overnight, home the next day
Most single-level cases go home the day after surgery. Multi-level cases stay one to two nights. Written aftercare and a 24-hour contact number.
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After
Follow-up, X-rays and rehab
Wound check at 10 to 14 days. Standing X-rays at 6 weeks and 3 months to confirm fusion. Graded return to desk work, driving and sport with physiotherapy.
Typical end-to-end: 2 to 4 weeks to surgery. Desk work: 2 to 4 weeks. Fusion X-ray: 3 months.
When it helps
When ACDF is the right step - and when it is not.
The cervical pathologies we see most, plus the mimics (ALS, multiple sclerosis) that must be excluded before any anterior fusion is booked.
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Cervical radiculopathy from disc herniation
Arm pain, numbness or weakness in a nerve-root pattern from a soft disc prolapse, unresolved after six to twelve weeks of non-operative care.
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Foraminal stenosis from uncovertebral spurs
Bony narrowing of the exit foramen compressing the nerve root, where anterior decompression and fusion restores foraminal height.
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Cervical spondylotic myelopathy
Progressive gait disturbance, hand clumsiness, hyperreflexia or bladder change with MRI cord compression. Surgical decompression is time-critical.
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Traumatic disc herniation or fracture
Post-traumatic instability or acute disc herniation with neurological deficit, once the fracture pattern has been characterised on CT.
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Ossification of the posterior longitudinal ligament
Focal OPLL amenable to anterior decompression, planned with CT. Extensive OPLL is usually treated posteriorly.
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Failed conservative care at six to twelve weeks
Ongoing radicular pain despite physiotherapy, medication and, where indicated, an image-guided nerve root injection.
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Adjacent-segment disease above or below a prior fusion
New symptomatic disc collapse at the level next to a previous ACDF, confirmed on MRI and flexion/extension films.
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Red flag: rapid neurological deterioration
A rapidly worsening gait, sphincter change or dense weakness needs same-day NHS admission, not a private booking.
Procedure options
ACDF is one of several options - and its cousins sit beside it.
What each option involves and which fits which pathology. For multi-level myelopathy or complex revision cases we refer within a specialist complex spine MDT.
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Single-level ACDF
The workhorse anterior operation for radiculopathy or focal myelopathy at C5/6 or C6/7. Fusion rate above 95 per cent with a PEEK, titanium or 3D-printed cage and anterior plate.
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Multi-level ACDF (2 to 4 levels)
Used for multi-level spondylotic myelopathy where anterior decompression is required. Non-union risk rises with each additional level, so cage choice and plating matter.
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Cervical disc replacement (cTDR)
Motion-preserving alternative for younger patients with soft-disc radiculopathy, preserved facets and preserved lordosis. Lower adjacent-segment disease at ten years in trial data.
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Laminoplasty
Posterior expansion of the spinal canal for multi-level myelopathy with preserved cervical lordosis. No fusion, so motion is preserved and adjacent-segment disease is reduced.
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Hybrid construct (ACDF + cTDR)
A fusion at one level combined with a disc replacement at another. Useful when the pathology at each level is genuinely different.
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Corpectomy and strut graft
When retrovertebral disease or OPLL crosses a vertebral body, the body itself is removed and reconstructed with a cage or strut, usually with a longer plate.
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Posterior cervical fusion
For rigid deformity, poor bone stock or when the anterior approach is unsafe (previous neck surgery, tracheostomy, radiotherapy). Larger operation, slower rehabilitation.
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Second-opinion review
A specialist review of your MRI, X-rays and clinical notes. Sometimes the answer is another six weeks of targeted physiotherapy, not surgery.
Our vetted London network
A small panel of complex spine surgeons, we picked them.
Consultants operating at HCA Wellington Complex Spine, London Bridge Spine Unit, RNOH Private Care, Nuffield Health Parkside and King's Private Healthcare. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every surgeon in our network.
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Consultant spinal surgeons with high-volume anterior cervical practices
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Hospitals meeting British Association of Spine Surgeons standards for complex spine
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Cervical disc replacement, laminoplasty and posterior fusion pathways in the same MDT
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Intra-operative neuromonitoring and consultant anaesthetist cover for every case
Safety and recovery
What to expect afterwards - honestly.
ACDF is a well-established operation with predictable outcomes: radiculopathy resolves in 90 to 95 per cent, myelopathy improves in 60 to 80 per cent. The things worth planning are dysphagia, the two to four-week rehabilitation window, and the long-term risk of adjacent-segment disease.
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Transient dysphagia
Difficulty swallowing after ACDF is common (5–30 per cent), usually settles within two to six weeks. Steroid infiltration and careful retraction reduce the risk.
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Recurrent laryngeal nerve palsy
Hoarseness from RLN neuropraxia occurs in 1–5 per cent, almost always temporary. Side of approach is chosen to reduce the risk in revision cases.
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C5 palsy after multi-level decompression
Deltoid and biceps weakness in 2–8 per cent of multi-level cases, usually recovers over three to twelve months. Discussed before consent.
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Non-union (pseudarthrosis)
Single-level fusion rate is above 95 per cent. Multi-level fusion rate is lower (85–95 per cent). Smoking is the single biggest modifiable risk.
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Adjacent-segment disease
Roughly 3 per cent per year risk of new degeneration at a neighbouring level, with cumulative risk over decades. cTDR reduces this in suitable patients.
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Soft collar for 2 to 4 weeks
Used selectively for comfort or in multi-level cases, not routinely for single-level ACDF. Written guidance is provided.
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Desk work at 2 to 4 weeks
Most single-level patients return to desk-based work within two to four weeks. Manual and driving jobs are individualised.
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Driving at 2 to 4 weeks, sport at 12
Return to driving is guided by neck rotation and comfort. Contact sport and heavy lifting are deferred until 12 weeks and fusion is confirmed radiographically.
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Red flags after discharge
New arm or leg weakness, expanding neck swelling, breathing difficulty, high fever, or a hoarse voice with choking on fluids: call the unit or go to A&E the same day.
Reading your operation note
Your ACDF note in four parts. Read the last one first.
Whichever construct was used, the note the surgeon sends you keeps to the same shape.
A quiet reminder
Spine language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Diagnosis, levels and construct
Which levels were operated on (for example C5/6, C6/7), the primary diagnosis (radiculopathy, myelopathy, adjacent-segment disease) and the implants used.
- 02 Technique
Discectomy, decompression and cage
The Smith-Robinson approach, extent of posterior longitudinal ligament release, cage material (PEEK, titanium, allograft or 3D-printed) and plate type. BMP is noted if used.
- 03 Findings
Intra-operative findings and monitoring
Cord compression seen, any dural leak, and the intra-operative neuromonitoring trace. Blood loss and length of surgery.
- 04 Impression
Fusion plan and rehabilitation
Read this first: expected admission length, collar advice, driving and return-to-work timing, and when standing X-rays are booked.
Recognised by major UK insurers
Cover for ACDF varies by insurer and by indication - usually funded when medically indicated. We confirm cover before booking.
Frequently asked
Everything we get asked about ACDF.
Quick answers on cost, alternatives, complications, and getting back to normal.
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What is ACDF and what does it treat?
ACDF stands for anterior cervical discectomy and fusion. Through a small transverse crease incision at the front of the neck, the surgeon removes a degenerate or herniated cervical disc, decompresses the spinal cord and nerve roots, and replaces the disc with an interbody cage and anterior plate. It is used for cervical radiculopathy, cervical spondylotic myelopathy, foraminal stenosis and, in selected cases, trauma or ossification of the posterior longitudinal ligament.
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How much does a private ACDF cost in the UK?
Roughly £20,000 to £32,000 for a single-level ACDF, £28,000 to £42,000 for two levels, £36,000 to £52,000 for three levels and £45,000 to £65,000 for four levels or a hybrid construct. A second-opinion review of your MRI and notes is £250 to £450. We confirm a firm quote within one working day.
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How successful is ACDF at relieving arm pain?
For cervical radiculopathy the resolution rate is 90 to 95 per cent when the MRI, examination and nerve conduction studies all line up. For cervical spondylotic myelopathy, meaningful improvement is seen in 60 to 80 per cent, with the primary aim being to halt progression rather than reverse long-standing cord damage.
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Should I have ACDF or a cervical disc replacement?
Cervical disc replacement is a strong alternative for younger patients with a single-level soft-disc radiculopathy, preserved facet joints and preserved lordosis. It preserves motion and reduces adjacent-segment disease over ten years. ACDF remains the standard for multi-level disease, significant facet arthropathy, deformity or extensive spondylosis. We talk both options through before you decide.
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What are the main risks?
Transient dysphagia in 5 to 30 per cent, recurrent laryngeal nerve palsy in 1 to 5 per cent, C5 palsy in 2 to 8 per cent of multi-level cases, non-union in 5 to 15 per cent of multi-level fusions, and adjacent-segment disease at roughly 3 per cent per year. Dural leak, wound haematoma and infection are uncommon. All risks are quoted honestly during consent.
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When can I get back to work, driving and sport?
Desk-based work at two to four weeks. Driving at two to four weeks once neck rotation and comfort allow. A soft collar is used selectively for comfort. Non-contact exercise from six weeks. Contact sport, heavy lifting and manual jobs are deferred to 12 weeks, once fusion is confirmed on standing X-rays.
Send your MRI, get an honest read
A named complex spine surgeon, matched to your MRI within a working day.
We look at your MRI, X-rays and story, and come back with two or three consultants across HCA Wellington, London Bridge Spine, RNOH Private, Nuffield Parkside or King's Private, with a firm quote for each.
Related treatments and conditions
Looking for something else?
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Cervical disc replacement
Motion-preserving alternative to ACDF for younger single-level radiculopathy.
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Scoliosis surgery
Correction of spinal deformity in adolescents and adults.
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Sacroiliac joint fusion
Minimally invasive fusion for confirmed SI joint pain.
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Kyphoplasty
Cement augmentation for painful vertebral compression fractures.
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Cervical radiculopathy
The clinical picture of nerve-root pain in the neck and arm.
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Cervical myelopathy
Spinal cord compression in the neck - and why timing matters.
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