Surgeries And Post Operative Care: What Do Patients Want?

The decision to proceed with cervical surgery is a very personal decision between the patient and their surgeon. Patients with overt spinal cord deformation on MRI/ CT myelogram should consider surgery at the earliest before irreversible spinal cord damage occurs. In general, patients with less severe symptoms that don’t improve after 6 weeks of adequate conservative measures are reasonable candidates for surgery. Obviously, any recommendation for surgery must take into account an analysis of risks vs benefits, especially with regard to pre-existing conditions, prior surgeries, age, and other factors.

Early mobilization and judiciously stretching the neck muscles minimize pain after cervical surgery. It is important to maintain good posture by keeping your shoulders back and relaxed. Avoid lifting anything over 6-8 pounds (as a guide, the weight of a full milk gallon). Do not lift anything above shoulder level. Perform small circular shoulder motions (shoulder rolls) with your arms extended and again with your arms at your sides to stretch shoulder and lower neck muscles. Arm circles while your arms are extended out the sides and your palms facing the ceiling while seated are useful as well. Mildly rotating your neck to alleviate the tightness is acceptable but avoid extreme motion, especially bending forward and backward. We also recommend walking at least a mile a day after the first week of surgery and up to three miles a day thereafter (this applies to our lumbar microdiskectomy; lumbar laminectomy; and lumbar decompression, fusion and instrumentation patients as well). All exercise programs should be cleared with your surgeon/physical therapist. Check with your surgeon regarding preference for use of a cervical collar as well as neck positioning during rest and sleep.

In general, vitamins that promote bone and collagen formation are useful after cervical spine surgery. These would include Vitamin C, Vitamin D with calcium, and a multivitamin tablet. After fusion surgery, certain medications should be avoided as well; aspirin, non-steroidal anti-inflammatory agents (like ibuprofen, Voltaren, Nuprin, etc.), Vitamin E supplements, and fish oil supplements should be avoided for 3 months after surgery as these agents can all inhibit bone formation. Always check with your surgeon for specific recommendations.

After undergoing cervical fusion surgery, returning to a usual healthy diet is important for a good outcome. A higher protein diet to promote healing is initially preferred, including adequate calcium intake. After anterior cervical surgery, a soft diet that is easy to swallow (pudding, scrambled eggs, oatmeal, Jello) will make the sore throat pain less bothersome. Laxatives are highly recommended for the first few days after surgery while you are on narcotic analgesics to minimize the development of constipation. This is no time to consider elective dieting for weight loss. Supplementing your healthy diet of grains, legumes, fruits, and vegetables with Vitamin C, Vitamin D, calcium, and a multivitamin in moderation is highly recommended. For the first couple of weeks, ensure extra protein intake from meat (90% lean or higher), poultry, fish, and tofu. Healthy amounts of water and fiber are essential as well.

It is best to discuss preparations for surgery directly with your surgeon. However, we generally advise our patients to definitely discontinue the use of all tobacco products for at least 3 weeks before surgery. Patients who continue to smoke have a much higher risk of poor outcomes after cervical fusion surgery, with increased rates of chronic pain, development of painful pseudoarthroses and breakdown at adjacent segments, etc, We ask all patients to shower with antibacterial soap for at least 7 days before surgery. Aspirin, all anti-inflammatory products, Vitamin E, and all fish oil products are discontinued for at least 7 days prior to surgery and are to be avoided for at least 3 months after any fusion surgery. Vitamin C, Vitamin D, calcium, and a daily multivitamin are recommended as soon as surgery is scheduled. All anticoagulants well as any specialty clearance evaluations (pulmonary, cardiac, neurologic, etc. ) should be addressed by your surgeon well in advance of the surgical date. Remain well hydrated for several days prior to your surgical date. Any and all questions should be communicated without hesitation to your surgical team to provide the best possible outcome.

Complications of anterior cervical spine surgery are dependent on the anatomy of the neck involved in the surgical approach. These would include but are not limited to: anesthetic risks; infection; hemorrhage; seroma (tissue fluid) formation; recurrent laryngeal nerve palsy resulting in hoarseness; hematoma formation; dysphagia (difficulty swallowing); scar formation; Horner’s syndrome (dilated pupil due to malfunctioning of autonomic nerves); cerebrospinal fluid leak; pharyngeal or esophageal injury; carotid injury resulting in stroke; hardware malpositioning or failure; adjacent segment breakdown requiring additional surgery; failure to alleviate pain; development of painful pseudoarthrosis; development of chronic pain; and nerve root/spinal cord injury resulting in pain, weakness, paralysis, impaired sensation, breathing difficulties; impaired bowel and bladder control; impaired sexual function; etc.

Complications resulting from a posterior cervical approach depend on the anatomy of the structures involving the posterior aspect of the neck and base of the skull. In addition to the usual complications associated with surgery (anesthetic complications, infection, bleeding, etc.), complications also include but are not limited to compression of the spinal cord or nerve roots as a result of hematoma formation; development of a seroma (tissue fluid accumulation); cerebrospinal fluid leak; delayed instability; vertebral artery injury resulting in stroke; hardware failure or malpositioning; development of painful pseudoarthrosis; adjacent segment disease due to arthritis formation at levels adjacent to the fusion; atrophy of the posterior cervical musculature; and chronic pain. The most serious complication would be spinal cord or nerve root injury resulting in pain, weakness, paralysis, impaired sensation; breathing difficulties, impaired bowel and bladder control, impaired sexual function, etc.

In almost all instances, any comfortable sleeping position is allowed after lumbar or cervical surgery, however, it is always best to check with your surgeon regarding what positioning of your neck and spine would be best during rest and sleep, as well as advice regarding use of cervical collar or other supportive accessories.