By Alok Sharan, MD, MHCDS, board-certified orthopedic spine surgeon · Medically reviewed November 1, 2026
Most cervical (neck) spine surgery, including ACDF, is done under general anesthesia with a breathing tube. Because the operation is close to your airway and spinal cord, the team plans three things carefully: placing the breathing tube without moving an injured neck, monitoring the spinal cord during surgery, and watching for swelling in the throat afterward.
What does the anesthesia team plan for in neck surgery?
| Consideration | Why it matters | What the team does |
|---|---|---|
| Placing the breathing tube | Tipping the head back can press on a narrowed spinal canal. | Uses a video laryngoscope or a flexible scope to keep the neck still; with an unstable spine, the tube may be placed while you are lightly sedated. |
| Spinal cord monitoring | Nerve signals show the cord is safe during surgery. | Uses IV anesthesia drugs (TIVA) that interfere less with nerve monitoring. |
| Positioning | Front-of-neck surgery (ACDF) is done face up; back-of-neck surgery is done face down. | Pads pressure points and keeps the head and neck aligned. |
| Blood pressure | Good blood flow protects a compressed spinal cord. | Keeps blood pressure in a target range throughout surgery. |
| Swelling after surgery | Swelling or a blood collection in the neck can narrow the airway. | Watches your breathing and neck closely in recovery; steroids are sometimes used in higher-risk patients. |
How common are breathing problems after ACDF?
They are rare. Across three large datasets, about 2 in 1,000 patients needed the breathing tube put back in within a day of ACDF. Neck hematoma (a blood collection) that affects breathing is reported in roughly 0.2% to 1.9% of anterior neck operations. This is why you are watched closely for the first hours after surgery. A sore throat and trouble swallowing are common for a few days and usually fade.
What should I tell my surgeon and anesthesiologist before neck surgery?
- Sleep apnea, or any past trouble with a breathing tube
- Blood thinners or anti-platelet medicines
- Symptoms that get worse when you tip your head back, such as electric shocks down the arms
- Heart or lung disease
- Bad reactions to anesthesia in the past
Talk to Dr. Sharan
To find out which option fits your spine, book a consultation with Dr. Alok Sharan at the Spine and Performance Institute in Edison, NJ: call (732) 898-3950.
References
- Wilson LA, Zubizarreta N, Bekeris J, et al. Risk factors for reintubation after anterior cervical discectomy and fusion surgery: evaluation of three observational data sets. Can J Anaesth. 2020;67(1). Link
- Palumbo MA, Aidlen JP, Daniels AH, Thakur NA, Caiati J. Airway compromise due to wound hematoma following anterior cervical spine surgery. Open Orthop J. 2012;6:108–113. Link
- Debkowska MP, et al. Acute post-operative airway complications following anterior cervical spine surgery. J Spine Surg. 2019;5(1):142–154. Link
- Fiani B, et al. Awake spine surgery: an eye-opening movement. Surg Neurol Int. 2021;12:222. Link
- Garg B, Ahuja K, Sharan AD. Regional anesthesia for spine surgery. J Am Acad Orthop Surg. 2022;30(17):809–819.
