Posterior Neck Surgery

Following your surgery, a moderate amount of neck pain is to be expected. It is common to have pain in the back of the neck and the shoulder blades. This pain gradually diminishes over the next several days to a week. Numbness or tingling in the arm or hand can be present or continue following your surgery. This will usually lessen over time. Difficulty swallowing and mild hoarseness sometimes develop and usually will resolve over time as well. 

You may have already noticed a reduction in your arm pain and/or numbness, and if you had arm weakness before surgery, you may have started feeling stronger already. You may also notice some improved balance and hand coordination if you had spinal cord compression. If you cannot appreciate any difference in your symptoms, do not be discouraged. This usually means that the nerve or spinal cord is still inflamed. Most patients continue to gradually improve over the course of months after their surgery. If you had surgery because of spinal cord compression and myelopathy, understand that complete neurologic recovery will take extensive physical therapy. You will continue to see improvements in balance and hand coordination up to 2 years after surgery. 

Before surgery, arrange for a friend or family member to be your helper for the first 1-2 days after surgery. Alter your house so that you have no objects that are in your path, and don’t need to buy food or do laundry. You are coming home to a clean area where you can rest. It may be helpful to prepare meals in advance and freeze them, so you don’t have to worry about cooking. 

It is important to schedule the surgery when it is convenient for you and your family to devote time to help you for at least 24 hours after surgery. 

It is important to eat healthy and take a multivitamin for the weeks prior to surgery. You want to exercise regularly as tolerated without aggravating your symptoms. You are preparing your body to facilitate recovery after surgery by being in best shape you can prior to surgery. 

The day before surgery you will be given a cleansing soap to wash with and Mupirocin ointment to use after surgery once the incision has fully healed. Rest well the night before surgery. 

Day of surgery

After you have recovered from anesthesia, you will be moved to the ambulatory area and gradually mobilized by the nurses. Once you have been able to walk and tolerate liquids, you will be discharged home if you have a scheduled same day outpatient surgery. You must have a friend or family member available to take you home from the hospital. The friend will ensure you are safely in your home and fill prescriptions for pain medication if necessary.

If you are staying in the hospital overnight, you will be transferred to the surgical floor where your family members can be with you. It is important to get up and mobilize with the nurses and physical therapists the same day as surgery. While in bed, you will be instructed to use SCDs on your legs. These are compressive devices that help pump blood through your legs to reduce the risk of blood clots. You will also be given an incentive spirometer to help with your breathing while in bed.

If you require home health services after surgery, that will be arranged prior to surgery. A nurse will come out to check on your incision and home physical therapy will be arranged for the first few weeks after surgery. I prefer to use Real Solutions Home Health Care because they are very good and know my post-operative protocols. However, if you are more comfortable with another company that you have prior experience with please let Jessica know prior to surgery.

Incision and Drain Care

1. If this applies to you: Home health nurse or rehab will perform dry/sterile dressing changes 2-3 times per week until we see you at the office at your 2 week post-op visit.
2. Keep incision clean and dry at all times.
3. Incision has “skin glue” (Dermabond). It will peel off on its own. Do not peel or pick at it.
4. You can shower 3 days after surgery. Pat the area dry and place a new dry/sterile dressing.
5. Do not scrub the incision site or put creams/ointments on it.
6. No bathing, swimming, or soaking the incision until instructed in your post-op visit.
7. All sutures are under your skin and will dissolve over time. You may have a loop of suture sticking out on each end of the incision. These will be removed at your 2 week post-op visit in the office.
8. Once your incision has healed, you will be given Mupirocin ointment to apply to incision
9. If you notice excessive swelling, redness, fever above 100.5, or significant amount of drainage from the incision site, contact the office.

Q: Do I have stitches that need to be removed? How do I care for a drain? 

A: Your incision is closed with stitches that are buried under the skin. These stitches are absorbable and will dissolve on own. There is medical glue that covers the incision. If the glue begins to peel off, it can be removed in 14 days.

If you are discharged with a drain, you will be shown before you go home how to empty it. This should be done daily and the amount of drainage should be recorded. A drain is typically ready to come out when the drainage is less than 30cc a day.

Q: When can I shower and get the incision wet? 

A: A clean gauze pad should cover the wound for 3 days after surgery after which you may shower. Once any drain is removed, you may allow the stream of water to go directly on the wound, but do not soap or scrub the area and do not immerse the incision in a bath. Do not apply vitamin E, powders, or ointments.

Q: Are there any problems with the incision that I should call the doctor about? 

A: If the incision becomes red and swollen, or the incision starts to drain fluid, call the doctor- an infection may be brewing. Another sign of infection is fever; call the doctor if you have any temperature over 100.5.

Brace and Bone Growth Stimulator

Q: When and how long do I wear the back brace for? 

A: You should wear your hard neck collar at all times for 4 weeks after surgery if you had a fusion and a soft neck collar for 2 weeks after surgery if you had a nonfusion laminoplasty, unless instructed otherwise by your surgeon.

Q: When do I use the bone growth stimulator? 

A: If you had a multilevel fusion performed, you will be given a bone growth stimulator to wear for a minimum of 4 hours per day for 6 months. This is recommended to supplement the fusion process and has been shown to reduce complications associated with bones not fusing.

Diet and Constipation

Q: Do I need to follow a special diet? 

A: There are no diet restrictions. Constipation and nausea are common side effects of prescription pain medication. If the medication makes you feel sick, discontinue its use. Constipation may be treated effectively with milk of magnesia (MOM), miralax and/or senekot tablets, medications that are available over-the-counter at a pharmacy. You may also drink prune juice to avoid constipation.

It is also important to eat a healthy well balanced diet, rich in fruits, vegetables, fiber and protein after surgery and take a multivitamin daily. Drink plenty of water (8 cups/day) if possible. Your body requires extra energy and protein to heal itself. Therefore, a good source of extra protein after surgery is helpful. You may take Ensure or Glucerna with every meal for 2 weeks after surgery. If you are a diabetic, be sure to check your blood sugar regularly and maintain normal levels.

Medications

Q: Will I be discharged with pain medications? 

A: Yes. Patients are usually discharged with a prescription for a narcotic painkiller such as Percocet. Strong pain medications are usually not needed for more than 1-2 weeks. They may cause drowsiness, nausea, vomiting and constipation. You should try to use the medication sparingly and substitute extra strength Tylenol when this can be comfortably done. Do not take aspirin or NSAIDs (Advil, Aleve, Motrin, Ibuprofen, Naprosyn, Celebrex, Mobic, Aspirin, etc.) for the first 2 months after surgery as these medicines can cause bleeding and interfere with bone healing.

If you need more pain medication, be sure to give the office 24 hours advance notice so that we can make the appropriate accommodations. You should also make sure to not take more than 3000mg of acetaminophen (Tylenol) per day. If you were taking blood thinners (Plavix, Coumadin, Eliquis, Xarelto, etc.) prior to surgery, do not resume until instructed to do so after surgery. Resuming too soon after surgery can result in dangerous bleeding into the spinal canal at the surgical site.

Sleep

Q: Is there any restriction on the position in which I sleep? 

A: You may sleep in any position that you find comfortable. For the first few days after surgery, normal swelling of the neck incision may make lying flat in bed uncomfortable. Try sleeping propped up with a reading pillow or with some pillows under the neck of the mattress. Do not sleep with pillow under head causing your neck to flex forward. You want your neck to be in a neutral alignment.

Activity and Exercises

Q: What should I do and not do? 

A: 

1. Avoid lifting anything heavier than a telephone book (5 pounds) during first two weeks after surgery.
2. If you had a cervical laminoplasty, I encourage gentle neck movement but no extreme turning or bending. If you are to work with a physical therapist, passive range of motion is permitted, but no vigorous neck exercises.
3. If you had a cervical fusion, I do not want you moving your neck while wearing the collar. If you are working with a physical therapist, arm and leg coordination exercises, and balance and gait training are permitted but no active cervical range of motion.
4. Do walk as much as tolerated. Much of the reconditioning is accomplished through taking many (6-10) small walks daily and slowly increasing the length and duration of walking.
5. Do not elevate your arms more than 45 degrees for first 2 weeks after surgery. This is to facilitate healing of your neck incision. Every time you elevate your arms overhead, you are pulling apart your incision.
6. Avoid going to events where you must sit for a prolonged period of time without moving. It is best to sit for one hour and then get up and walk around. Listen to your body, many people can only sit for 15 minutes before needing to get up and move around.
7. Do not use low chairs or soft cushioned chairs for sitting without support.
8. You may use stairs after surgery, however, be certain to start slowly and use handrails. Walk with someone else for the first few days to have someone near you to ensure stability until you are comfortable.
9. No driving a car until you are no longer taking narcotic pain medication and no longer wearing rigid cervical collar. You may travel in a car as a passenger wearing your collar.
10. If this applies to you: you will be sent home with physical therapy and/or occupational therapy. At your 2 week post-op visit, you will be transitioned to office-based physical therapy.
11. In general, by 4 months after surgery you will be allowed to return to unrestricted activity, including noncontact sports.

Arm and Neck Discomfort

Q: Should I be alarmed if I feel neck pain and stiffness? 

A: Neck stiffness and ache between the shoulders is very common in the first weeks after surgery. This usually goes away on its own. Warm compress or showers and gentle massage are often very helpful to relieve symptoms. If the muscle stiffness remains bothersome, the doctor may prescribe a muscle relaxant medication.

Q: I began to feel a burning and tingling feeling in my arm. Is this a problem? 

A: Some patients notice bothersome tingling or burning in the arm in the first 3 weeks after surgery and is not cause for alarm. This is usually caused by nerve irritation or nerve swelling from the surgery and goes away on its own. If the symptoms worsen or persist, however, call the doctor.

Return to Work

Q: When can I return to work? 

A: Patients may return to light office work about 2 weeks after a laminoplasty and 4 weeks after a fusion. However, you may need some more time to recover no matter what type of surgery you have.

Returning to work will be assessed on an individual basis at your surgeon’s discretion depending on type of surgery you have. Those whose work involves heavy labor, such as plumbers and construction workers, generally should not return to full duty for six weeks. Please discuss with your doctor about your particular job so that a sensible plan can be made for returning to work.

Appointments

Q: When will I see the Doctor again?

A: You will be given an appointment to see your surgeon or PA two weeks following surgery to get follow-up x-rays, evaluation and wound check. You will then see the surgical team several more times after surgery.

Q: Disability forms?

A: Forms for disability and leave of absence should be dropped off at the office or faxed. If you mail us the form, it takes 2-4 weeks to get the letter. Forms are usually ready for pick-up or fax within 1-2 business days.