Cervical Spine Orthopedics II Practice Exam

The key idea is that ACDF is used to directly relieve ventral compression that’s causing radicular symptoms and to stabilize the affected motion segment. When a patient has nerve root symptoms on one side (unilateral radiculopathy) due to a lesion in front of the spinal cord (a ventral compressive pathology like a disc herniation or focal osseous spur) that has not improved with conservative treatment, removing the offending disc material and fusing the level addresses both decompression and stability. That’s why this scenario is the classic indication.

If the problem involves multilevel or dorsal (behind-the-nerve) compression causing myelopathy, or if there’s bilateral symptoms without a ventral lesion, ACDF is less appropriate as the primary operation because it won’t reliably decompress dorsal structures or address multilevel disease. Pure axial neck pain without radiculopathy isn’t an indication for fusion either, since there’s no nerve compression to relieve.

So the best choice reflects decompressing and stabilizing a ventral lesion causing unilateral radicular symptoms that have failed conservative care.