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POSTERIOR CERVICAL DECOMPRESSION AND FUSION POSTOPERATIVE AND HOME RECOVERY INSTRUCTIONS

AFTER YOUR OPERATION

 

Pain

After surgery you may experience pain in the region of the incision. Some neck and arm pain as well as tingling or numbness may also be present. Initially it may be of greater intensity than pre-operatively, but will subside over time as the healing process occurs. This discomfort is caused from surgical retraction of tissue as well as inflammation and swelling of the previously compressed nerves. Some patients experience a sore throat and swallowing difficulty after general anesthesia and surgery. This is from manipulation of tissue and the presence of the breathing tube for anesthesia. The sore throat usually will subside within a week. The swallowing difficulty may take longer. Using throat lozenges or lemon drops, sipping cool liquids, or sucking ice chips may soothe this pain. 

 

Use of Pain Medication

Narcotic pain medication will be available for pain relief after surgery. Narcotics are very effective for pain relief but may cause other side effects. The possible effects vary among patients and may include: sleepiness, nausea, constipation, flushing, sweating, and occasionally euphoria or confused feelings. If these occur notify your nurse. For your protection, you will receive narcotic medication only when you request it and if deemed medically appropriate by your physician. Do not take anti-inflammatory medicines such as Celebrex, Advil, Aleve, or Motrin, as these may affect your bone healing for 11 months following your surgery. Narcotics will not be considered for refills on weekends, holidays, or at night. 

 

Activity

Feel free to move about in your bed. The nurse or therapist will assist you in getting out of bed for a short walk a few hours after surgery. You will be instructed to be up walking every 2 to 3 hours during the day and evening. As you recover, the nurse will allow you to do this independently once you are steady and feel comfortable. Early activity after surgery is extremely important to help prevent the complications of prolonged bed rest such as pneumonia and blood clots. It also promotes recovery, relieves muscle stiffness, allows for development of a well-organized scar, and improves your outlook. Elastic stockings (TED hose) were given to you immediately after surgery to prevent phlebitis (inflammation in your veins) in your legs. You may remove them after being discharged from the hospital. Do not start any programs of exercise or physical therapy unless discussed with your doctor. 

 

Diet

Your diet will begin with clear liquids, and be advanced to your normal daily diet as soon as your condition permits. Your IV will be removed as soon as we are reasonably certain it will no longer be required for medications and hydration. 

 

Bowel and Bladder Function

During surgery you may have a catheter (tube) in your bladder to monitor your urine output. Upon its removal you may feel a stinging sensation for 2 to 3 days, which is normal. Some patients may have difficulty urinating after surgery. If this occurs, notify your nurse who may assist you in voiding techniques. This may require placing a catheter in your bladder. After surgery, constipation frequently occurs from inactivity and the side effects of pain medication. Stool softeners and laxatives will be available. 

 

Respiratory Hygiene

Deep breathing is very important after surgery to maintain lung expansion and reduce the risk of pneumonia. You will be provided with an incentive spirometer and instructed about its use. This device should be used every 15 to 30 minutes during your wakeful hours initially, then every 1 to 2 hours as your Activity returns to normal. This device is yours to take home. Continue to use it at home for at least 1 week after your discharge. Smoking is absolutely forbidden. There is clear evidence that smoking dramatically increases your risk of post-operative complications. There is also evidence that smoking adversely effects bone healing and nerve recovery. Second hand smoke also applies, so family members and friends should avoid smoking while around you. 

 

Use of Your Neck Collar

A cervical collar or brace will be applied immediately following surgery. Support and immobilization after surgery minimizes the risk of displacement of the bone graft. It serves as a reminder and keeps your head supported. It also reduces discomfort and facilitates healing. The collar should fit snugly, yet comfortably. It should allow only minimal motion. Do not “fight” the collar; cooperate with it. This will assist in bone healing and minimize neck discomfort and skin irritation. You should be wearing your collar at all times until told to discontinue, typically 6-8 weeks. An information sheet will accompany your collar and instruct you on its proper care and use. You may find that two collars are convenient, wearing one while the other dries. 

 

HOME RECOVERY

 

Follow-Up Appointment

Patients are generally discharged from the hospital 1 to 2 days after surgery. A follow-up appointment was made for Dr Ravi's office 2-3 weeks from the date of surgery. At your follow-up visits, you will receive an x-ray of your neck the morning of your appointment. 

 

Incision Care

After the 3rd post-operative day, you are encouraged to shower daily. Do not soak your incision. Pat the incision dry. Do not apply any ointments or creams. Cover daily, for the first 5 days, with a clean dressing. Surgical tapes or Steri-strips may be present to aid in holding the skin edges together. Allow these to fall off on their own. After five days post-operatively you no longer need to wear a bandage. NO BATHS, HOT TUBS, OR POOLS FOR 6 WEEKS AFTER SURGERY, it will increase your risk of infection. 

 

Inflammation

Please take your temperature every afternoon for the first week after you are discharged from the hospital. Call your physician if: 

  • Your temperature taken by thermometer, is more than 101.5 degrees,

  • Your incision becomes reddened, swollen or any drainage occurs, or

  • Your pain increases out of anticipated parameters.

 

Nutrition

A well-balanced diet is necessary for good healing and recovery. This includes food from the four basic food groups: dairy products, meat, vegetables and fruit. Use of narcotic pain medication and prolonged rest may cause constipation. Drinking plenty of fluids and eating high fiber foods (whole grains, raw fruits and vegetables) will help regain normal bowel function. 

 

Home Pain and Medication

When we surgically relieve pressure from an inflamed, damaged nerve it does not recover instantaneously. The surgical procedure does not heal the nerve, only the body is capable of that. The goal of surgery is to create the best possible environment for the body to heal itself and to prevent further damage. This will take a variable length of time depending on the duration and degree of nerve damage and the body’s own healing abilities. Most of the healing occurs in the first few months. Pain, weakness, or numbness lasting more than six months will likely be permanent. Everyone has a different pain tolerance that will dictate the amount of pain medication required. A decreased dose and less frequent use of pain medication will occur during your recovery period. A gradual weaning of medications should begin as soon as possible, generally within 2 to 4 weeks. Conservative use of narcotic pain medication is advised. One should try non-narcotic medication, such as Tylenol and reserve narcotics for more severe pain. While using narcotic pain medication you SHOULD NOT drive. One should try non-narcotic medication, such as Tylenol and reserve narcotics for only the difficult times. Do not take anti-inflammatory medicines such as Celebrex, Advil, Aleve, or Motrin, as these may affect your bone healing for 11 months following your surgery. Narcotics will not be considered for refills on weekends, holidays, or at night. 

 

Home Activity

 

Your recovery is an essential part of your surgical process. Following these guidelines and the instructions given to you by your physician and nurse will provide you with the best opportunity to return to your desired activities as completely as possible. 

 

The First Week

  • Early to bed, late to rise and frequent rest periods throughout the day. Get at least 8 hours of sleep each night. A disrupted sleep pattern is common after discharge from the hospital and will return to normal over time.

  • You may not drive, but you may be driven, for short distances, using proper restraints such as shoulder and lap belts for 4 WEEKS or until the collar is removed and you are no longer taking narcotics.

  • No lifting of more than 4 pounds

  • May climb stairs with hand rail

  • Begin a daily walking program with 1 to 2 blocks initially; schedule a daily time and increase distance daily.

  • Eat a regular, balanced diet.

  • Take medications as prescribed, using narcotics as needed.

 

The Second Week

  • Resume normal rising and retiring schedule, but continue to rest throughout the day.

  • You may not drive.

  • No lifting of anything weighing more than 4 pounds.

  • May climb stairs with hand rail

  • Continue scheduled walking, increasing distance and frequency as able.

  • May resume sexual relations when comfortable.

  • Begin narcotic weaning as pain diminishes, relying mainly on non-narcotic medications

  • Follow-up in the office with your physician or nurse, as scheduled, for further instructions.

 

The Third Week

  • Resume normal rising and retiring schedule, resting as needed.

  • May resume light work around the home; lifting not to exceed 10 pounds.

  • Continue scheduled walking.

 

The Fourth Week

  • Resume normal rising and retiring schedule, resting as needed.

  • May resume light work around the home; lifting not to exceed 10 pounds.

  • Continue scheduled walking.

 

Disability

The usual period of recovery for cervical disc surgery is 8 to 12 weeks and complete healing may take from 3 to 6 months. Some patients may return to work sooner than others depending on their job, response to surgery, and ability to perform other lighter tasks in the work place. Physician approval is required prior to returning to work. If your employer requires documentation of your work status, our office will provide the necessary information to your employer or other concerned parties. A mild physical therapy program may be initiated after 6 weeks. This will depend on how your fusion is healing. A more aggressive physical therapy regimen will be initiated on follow-up visits dependent on x-ray verification of your fusion status.

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