Cervical Spine Surgery…What to Expect You have been scheduled for cervical spine surgery and are probably wondering what to expect with your surgical journey. We will discuss pre-‐operative tasks, the day of surgery, recovery in the hospital, and recovery at home. 1. Pre-‐operative tasks: a. Your surgeon will discuss the proposed surgery with you and “post” your surgery. The medical secretary will work with you to arrange your surgical date and coordinate the necessary tests your primary care physician will need to order. You may need to see all your treating physicians, such as a cardiologist, in order to determine if you are medically safe to have surgery. ALL lab work, chest x-‐ray, EKG, and medical clearance/physical must be completed within thirty days before surgery and at least seven days before surgery. b. Medications: Discuss your current medications with your primary care physician for guidance as to when to take your last dose prior to surgery. Some medications you are allowed to take the morning of surgery, others need to be discontinued 24 hours before and still others 10 days before surgery. Please see the attached medication guideline. If medications are not stopped as directed by your physician, your surgery will be canceled! c. Preparing your home prior to surgery: Remove scatter rugs or other obstacles which may prevent you from moving about freely. Place anything you may need within reach, to avoid bending, lifting, or twisting. For example, using liquid soap in the shower instead of a bar soap which can drop. Also, be certain your medications, remote control, etc. are within easy reach on a bedside table. Place items in your kitchen and bathroom where you can reach them without bending over or reaching above your head. d. FMLA/disability paperwork: If forms or paperwork need to be completed for your employer, please send them to our office as soon as you can. The forms must have your name on them and as well as specific information for completion-‐for example, how you wish to receive the form once it is completed. Forms may take 7-‐10 business days for completion so please plan ahead. 2. The night before surgery: a. Your last meal should be eaten by 8pm and your last liquid by midnight. This also includes mints and gum. If you must take medications after midnight, do so with only a sip of water. b. Prepare your overnight bag: Include loose fitting clothing and slip on shoes with a non-‐skid sole. Pack a button down shirt, not a pull over shirt. If you have asthma, you may pack your inhaler (labeled) but do not pack any other medications from home. If you use a C-‐PAP machine, pack that as well. c. Bring your MRI or CT scan films/CD the day of surgery. If the studies are online, they can be viewed in the OR. If the surgeon cannot view your studies during surgery, your surgery may be canceled! 3. The day of surgery: a. Please report to GBMC two hours before your surgery is scheduled to begin (see flyer for complete directions). Have your MRI or CT films, insurance information and a photo ID. Also, bring the completed Outpatient Home Medication Reconciliation Form which lists all your current medications. b. Pre-‐op area: you will be cleansed with skin prep cleaner prior to surgery and changed into a gown. The nurses will start an IV to prepare for surgery. The nurse will also ask you to tell them the surgery you are scheduled for and your medical history, including your last meal and medications you are taking. c. Your family: Two members of your family will be allowed in the pre-‐op area. d. The recovery room: Expect to stay in the recovery room for approximately two hours. You will have an IV, oxygen, and compression stockings on your legs. e. You may be discharged the day of surgery or you may spend the night. This can vary with age, the extent of the surgery, the time of day of the surgery, and other medical risk factors. If you are staying an extended period of time, your family can purchase parking passes in the Boutique, located on the third floor of the hospital. f. If you brought MRI or CT films/CD for surgery, be sure to ask for them back. Once you have left the hospital it is possible that the films may not be located. 4. Home: a. Cervical Collar: Most patients are given a soft cervical collar (foam) to wear for comfort for six weeks following surgery. You will be given a collar prior to leaving the hospital. The soft cervical collar should be worn in the car but other than that it is for comfort only, including lying in bed. Some patients are required to wear a hard cervical collar 24 hours a day. b. Incision: Most incisions are “glued” with steri strips over the incision. The strips may fall off on their own, if not they will be removed at your wound check appointment with the nurse at the surgeon’s office. Sometimes the surgeon will close the incision with staples or sutures and if so, they will be removed at your c.
wound check appointment. Check your incision each day and call our office immediately if there are any signs of infection: redness, increased pain, increased swelling, thick drainage, fevers above 100.5. If there has been no drainage for 24 hours, the incision does not need to be covered with a dressing. Activity: Rest, rest, rest! You are encouraged to walk on a level surface each day to increase your strength and endurance but no other exercise is recommended. Limit use of steps your first week or longer depending on your strength. Even computer use should be limited to 1-‐2 hours at a time and then change positions, being alert to good posture at the computer. Listen to your body, change your position frequently, and remember to rest. Symptoms: • It is normal to still experience pain following surgery. Your pain will gradually decrease over six to twelve weeks. Any numbness or tingling you felt before surgery may continue for up to six months following surgery. The numbness or tingling may even come and go in this time period as your nerves are healing. • You may have difficulty swallowing some foods for the first two weeks after surgery. This will feel like a “lump” inside your throat. Take small bites of food and supplement your diet with puddings and milk shakes as needed. Ice chips, cold fluids, and cepacol spray may help. • It is also normal to have tightness and burning across your shoulders. Taking a muscle relaxer will help with these symptoms. • You will have good and bad days in your recovery! Listen to your body, change your position frequently and remember to rest. Restrictions for the first six weeks following surgery: • No lifting, pushing, or pulling more than 10 pounds (a gallon of milk) • Do not lay or sleep on your stomach • No driving for six weeks • No working for six to twelve weeks unless otherwise specified by your surgeon Pain Medications: Upon hospital discharge, you will be given prescriptions for pain medication and a muscle relaxer. You will be given enough medication to last until your wound check appointment in our office. Subsequent refills will have enough quantity for at least fifteen days. Some prescriptions cannot be called or faxed to your pharmacy and will need to be mailed or picked up from our office. Refills will not be addressed afterhours or on the weekend. Please call our office three days before the refill is needed to ensure enough time so you will not be without your medication. The first two weeks after surgery are typically when your pain is at the highest level. Use your medications as needed to keep you as comfortable as possible. Use your medications as prescribed-‐do not use more than the prescription allows. If your pain is not controlled, call our office. The surgeon will provide pain medications as needed for up to three months following surgery. With each refill, our office works closely with you to wean your medications as tolerated. If you are unable to wean completely off your pain medication we may require the assistance of a pain management physician to assist with weaning the medications. g. Stool Softeners: Pain medication and anesthesia can cause constipation. Drink plenty of fluids, walk as you tolerate, and use over the counter stool softeners as needed, such as Colace. If a mild laxative is needed, Senokot is recommended. Use these over the counter medications as needed per the package directions. h. NSAIDs: non-‐steroidal anti-‐inflammatory medications, such as Ibuprofen, Advil, Motrin, and Aleve should not be used for four week following a fusion surgery. NSAIDs are allowed following TDR (total disc replacement) surgery. i. Bone Growth Stimulators: Your surgeon may decide to order a Bone Growth Stimulator for you. Not every patient will require this device. If you surgeon feels this is needed to help your fusion to heal, you will receive a call from our office following surgery. 5. Post-‐operative Appointments: a. Appointments for your wound check and six week appointment will be made at the time the surgical date is planned. • The Wound Check appointment is generally 7-‐14 days after surgery. You will see a Registered Nurse, who will assess your incision and remove staples or sutures as indicated. Post-‐operative questions and medication refills will be discussed. If applicable, an x-‐ray order may be given to be done just prior to the six week appointment. • The Six Week Post-‐operative appointment will be with your surgeon. If applicable, your x-‐ray will be reviewed and activity and work status questions will be addressed. Physical therapy may be ordered at this visit and is typically ordered for 2-‐3 times per week for 4-‐6 weeks. The surgeon may or may not request a twelve week appointment; this is based on the discretion of the surgeon.