ACF Anterior Cervical Fusion for an unstable cervical spine This operation should be reserved only for those patients who have documented evidence of spinal instability, ie., spondylolisthesis or subluxations, documented by flexion-extension x- rays or other radiologic studies. This is an "open" surgery, performed under general anesthesia, by making a small incision in a skin crease anteriorly in the neck. When the spine is exposed, an operating microscope is used to provide maximum light and magnification. The disc and/or bone spurs are removed and then a bone graft (taken either from the hip or a donor) is inserted in the space formerly occupied by the disc. The use of a titanium plate to further stabilize the spine is optional. The operation takes approximately two hours. One or two discs can be removed through the same incision.