Cervical Herniated Disc(s)
Cervical Degenerative Disc Disease
ACDF – Anterior Cervical Discectomy and Fusion
- This procedure is usually done as an outpatient procedure depending on the duration and severity of your neck condition(s).
- Advancements in Minimally Invasive spine surgery technologies used for cervical fusions, has allowed most of my patients to go home within 24 hours, although some patients may sometimes require longer periods of time
- Most cervical fusion surgeries require a soft collar (at minimum) for the first 2 weeks following surgery unless otherwise indicated
- Sometimes a hard collar is warranted and must be worn 24/7 until further instructed
“HARD” OR ASPEN COLLAR
THINGS TO AVOID AFTER SURGERY
- Removing the cervical brace for any reason other than to shower
- Lifting or carrying anything more than 3 pounds until further instructed.
- Anything that puts undo stress on the neck or upper shoulders. This could also cause some increased pain post-operatively
- Avoid overhead and/or sexual activities until further instructed
- Removing a hard collar at any time prior to the 6 weeks following surgery, could delay or prevent the cervical fusion from completely healing
POSITIONS OF COMFORT
- Sitting, reclining, and/or lying flat – as long as there is not a great deal of pressure on your most surgical location
- Showering is acceptable after the first 24 hours of surgery
- Since you are required to wear your hard cervical collar 24/7 for the next 6 weeks (at minimum), it is going to be difficult for you to get comfortable in the first 2 weeks with sitting, sleeping, and/or being able to get around at home.
- The easiest thing to remember is that the most comfortable position during your recovery in the hard collar is usually the safest position
- After your surgery, you are not allowed to drive during the first 2-6 weeks in the post-operative period
- Please be careful of the shoulder harness, as you do not want this to lie across or catch your neck in case of an accident
- You will be able to ride in a car as long as you are in your brace, comfortable, and in the car only for short periods of time. If the car ride is greater than 1 hour, you will need to pull over so that you can get out of the car and stretch
- Although you should be avoiding any bending, lifting, or twisting motions, you will also want to minimize your sitting too. It is important for you to try and stand and better yet, walk in increasing amounts every day to build up your conditioning.
- Make a determined effort to walk at least 3 times a day
- Your initial walking time may only be 5 to 10 minutes the first time, and that is ok to do, but this should increase every day so that by 3 weeks after surgery, you are walking up to 1 mile
DRESSINGS AND WOUND CARE
- It is important to keep the dressing dry underneath your collar. Most of the time, dissolvable sutures were used and there will be no stitches to be removed later
- You will either have special water-resistant “glue” called Dermabond over your incision site. Although you may shower within the first 24 – 48 hours after surgery, your wound must remain covered for protection. You cannot shower with the wound uncovered for at least 7 days after your surgery.
- When you do take a shower, please have someone there to help you if in the event you drop the soap or need shampoo. I would rather you not bend over to pick it up, but instead have someone retrieve this for you
- Please do not submerge your incision site(s), this includes avoiding pools, hot tubs, or baths until further instructed
- If your dressing does get wet for some reason, get some help in changing your dressing immediately with a sterile piece of gauze (usually 2 x 2 inch or 4 x 4 inch size) which you can get at any drug store and secure with a piece of medical tape
- If your incision sites begin to bother you or you begin to notice any drainage of any sort on the dressing, it is worth a phone call and possibly a sooner follow-up appointment to look at the wound – CALL IMMEDIATELY!
- Occasionally, the suture ends or “tails” are outside of the skin and might be secured with steri-strips (bandaid on steroids), this is normal
- If there is any concern regarding the incision site(s) – such as any significant redness, warmth, discharge, or excessive swelling around the incision, please notify me immediately
- Finally, replace the collar after the new dressing has been applied
STOCKINGS AND BLOOD CLOTS
- You will have TED hose stockings when you leave the hospital. These special stockings help to prevent blood clots in your legs
- Please wear these stockings at least 23 hours every day until your follow-up visit. They may be removed for brief periods of time for personal hygiene purposes or to wash/dry them
- Please remove them only at a time when you can be up walking around. This walking helps to further prevent blood clots. Do Not Remove the stockings when lying down.
- Occasionally, I may prescribe an Aspirin such as 325mg daily as an occasional measure to help prevent blood clots. This Aspirin is usually started on the the 3rd day after surgery (Post-Op Day #3) and you should continue to take until further instructed
- The best way to prevent blood clots is to do “ankle pumps” that the physical therapist showed you in addition to walking
- If you do get significant swelling of either leg, especially if accompanied by pain in the calf, it is important to notify me IMMEDIATELY!
- Be sure to take your incentive spirometer home when you are discharged from the hospital.
- This is “Breathing Machine” that you used at your bedside.
- Try for at least 10 times every hour while you are awake with a goal of 2500 liters
- Use this a home on a regular basis for the first 3 weeks after surgery. This helps to get oxygen to your lungs and helps to prevent pneumonia.
- You will be provided with your prescriptions prior to your discharge from the hospital. This will usually include medications for pain, muscle relaxants, and a number of different supplements to help in your healing process
- We will also go over in detail what home medications you can/cannot take prior to your discharge. Some of these medications can cause side effects and interactions that we would like to avoid
- At the time of your pre-operative visit, a follow-up appointment will be made for you. Usually my follow-up appointments are within 2 weeks after surgery or sooner if something should occur unexpectedly
- Your first post-operative visit will include a thorough evaluation of your wound, medication review, dressing changes, and a X-ray after surgery
- At that time, if you are doing well, the TED hose stockings will be discontinued and your activities will be advanced accordingly
- Please call if you do not already have a scheduled, follow-up appointment
- The usual sequence of follow-up appointments are within 2 weeks immediately following your surgery, then every 4 to 6 weeks for follow-up evaluations
RETURN TO WORK
- Most patients with work-related activities will not be allowed to return to work of any type unless it is a sedentary-type of position
- We may be able to place some restrictions on you, and your work may be of limited capacity for at least 4 weeks following your cervical surgery
- For those whose job is more demanding and require heavier lifting and/or carrying, the earliest return to work will be no sooner than 2 months immediately following your surgery
- On the 6 week follow-up appointment, we will obtain flexion/extension (Flex/Ex) views to evaluate the cervical fusion itself
- Once the Flex/Ex X-rays are evaluated, you will likely be switched from the Hard cervical collar to the Soft cervical collar at that time
- Usually occurs at least 3 times a week for at least 4 to 6 weeks after your surgery
- At each post-operative appointment, your physical therapy will be addressed for your functional status
- Your Physical Therapist will recommend specific exercises and movements that I have reviewed, please try to utilize these exercises to enhance your successful outcome
- Consider also adding cardiovascular exercises to your regiment, as it is helpful towards maintaining the health of your back
- Please avoid smoking as it has been shown to many detrimental effects towards your health and healing processes