To best understand your surgery, it is important to know about your spine. The spinal column surrounds and protects your spinal cord. Your spinal column is made up of 24 vertebrae (bones), plus the sacrum and the tailbone (coccyx). Each vertebra is separated by shock-absorbing discs. These discs give your spine flexibility to move and bend. Nerves branch out from your spinal cord and pass through openings in these vertebrae to other parts of your body.
What is Cervical Spine Surgery ?
The goal of cervical spine surgery is to relieve pain, numbness, tingling and weakness, restore nerve function and stop or prevent abnormal motion in the spine. Your surgeon does this by removing a disc or a bone and fusing the vertebrae together with a bone graft either in front of or behind the spine. The bone graft may be one of two types: an autograft (bone taken from your body) or an allograft (bone from a bone bank). Sometimes metal plates, screws or wires are also used to further stabilize the spine. These techniques are called instrumentation. When the vertebrae have been surgically stabilized, abnormal motion is stopped and function is restored to the spinal nerves.
What are the Reasons for Cervical Spine Surgery ?
Cervical spine surgery may be indicated for a variety of cervical spine problems. Generally, surgery may be performed for degenerative disorders, trauma or instability. These conditions may produce pressure on the spinal cord or on the nerves coming from the spine.
What Conditions are Treated with Cervical Spine Surgery ?
Degenerative Disease
In degenerative disease the discs or cushion pads between your vertebrae shrink, causing wearing of the disc, which may lead to herniation. You may also have arthritic areas in your spine. This degeneration can cause pain, numbness, tingling and weakness from the pressure on the spinal nerves.
Herniation of disc material results in nerve root pressure and irritation.
Stenosis limits room in the foramen creating nerve root and spinal cord pressure.
Cervical Deformity
Patients with a deformity in their cervical spine, such as hyperlordosis or swan neck deformity, may benefit from surgery to straighten and stabilize the spine. Injury Since the neck is so flexible it is vulnerable to injury. Some injuries can cause a fracture and or dislocation of the cervical vertebra. In a severe injury the spinal cord may also be damaged. Patients with a fracture, especially with spinal cord damage, undergo surgery to relieve pressure on the spinal cord and stabilize the spine.
What are the Potential Complications of Cervical Spine Surgery ?
As with any operation, there are risks involved with cervical spine surgery. Possible complications include injury to your spinal cord, nerves, esophagus, carotid artery or vocal cords; non-healing of the bony fusion; failure to improve; instrumentation breakage and/or failure; infection; bone graft site pain. Any of these complications may lead to more surgery.
Other complications may include phlebitis in your legs, blood clots in the lungs or urinary problems.
Rare complications include paralysis and possibly death. Your doctor will discuss potential risks with you before asking you to sign a consent form.
How is Revision Surgery different ?
Revision surgery often requires correcting a deformity. The type of revision depends on the type of problem. The procedure may include operating on both the front and back of the neck.
The incidence of complications from cervical spine revision surgery is higher than in first-time procedures. It is also more difficult to relieve pain and restore nerve function in revision surgery. Patients should also be aware that the chance of having long-term neck pain is increased with revision surgery.
Cervical Spine Surgery: Preparation Steps
Preparing For Surgery - Preparing Your Home : -
Before coming to the hospital, you can do some things to prepare your home to make your recovery easier, such as : -
Place the telephone in a convenient area, such as near the bed or chair.
Prepare food or purchase easy-to-prepare foods before you come to the hospital.
Identify a person who will be able to help you with shopping and other chores.
Move food, pots, pans and other cooking utensils to high shelves or other counter tops so you can avoid bending.
Place shoes, clothing and toiletries at a height where you can reach them without bending.
Remove or secure any throw rugs so you won't trip over them.
Think about what changes you'll make if you need to stay on one floor.
Equipment Needs : -
You will be fitted for a neck collar/brace or halo brace before surgery. The brace is an important part of your recovery process. Your therapist and doctor may also prescribe several types of medical equipment to help you in your recovery. Insurance coverage for equipment varies from one company to another and may change over time. You should check with your insurance company to find out if you have coverage for durable medical equipment (DME), such as a walker or commode, so you can prepare for any co-pay or equipment that may not be covered.
The physical therapist and home-care coordinator will help order the equipment and verify your insurance coverage. Your medical equipment will be ordered a few days before your discharge and delivered to your home. Please arrange for someone to be home to accept the delivery.
Medical equipment may include : -
Walker
Elevated commode or toilet seat extender
Tub seat, bench or chair to use in the bathtub or shower
Long-handled reacher
Hospital beds are necessary only for patients with specific medical needs and must be prescribed by your doctor. Most patients do not require a hospital bed after cervical spine surgery.
Transportation Home : -
You may travel home from the hospital by car, either reclining in the front passenger seat or lying down in the back seat. You must arrange for your own transportation home. Once you are home you may not drive until told otherwise by your doctor. In fact, it is illegal to drive while wearing a collar or brace. However, you may take short car rides as a passenger. If you have any questions about driving, please talk to your doctor.
Medication : -
Please stop taking aspirin and nonsteroidal anti-inflammatory medicines (NSAIDs), such as Ibuprofen and Indocin, two weeks before your surgery. If you aren't sure which of your medications are nonsteroidal anti- inflammatory medicines, check with your doctor or pharmacist. Once your NSAIDs are discontinued, you may take extra-strength Tylenol for pain relief. If this does not relieve your pain, call your doctor for other pain-relieving medicine.
If you take aspirin or Coumadin for a heart condition, please contact your doctor for further instructions. On the day of surgery, please bring a list of your routine medications with you to the hospital.
Stop Smoking : -
If you smoke, it is important that you stop smoking for at least two weeks before your surgery and for six weeks after your surgery. Studies have shown that smoking interferes with healing of your bone graft.
Medical Doctor : -
Your orthopedic doctor may ask you to visit a medical doctor to be sure you have no health problems that could interfere with your surgery. The medical doctor will confer with your family physician or internist about any specific medical problems you may have. He or she will also follow your medical status during your hospital stay.
Preadmission Testing and Evaluation : -
Your doctor's office will schedule your appointment to have a preadmission evaluation.
which may include some or all of the following : -
Medical history and physical examination by a nurse practitioner
Anesthesia interview
Blood and urine tests
Electrocardiogram
Spine X-rays, MRI, CT Scan or myelogram as needed
Patient teaching
Blood Donations : -
Autologous blood donation is available for patients interested in giving their blood and having it held for their use during and after the operation. About two to four weeks before your surgery you can donate one unit of your blood. You can donate your blood at your local American Red Cross. Your doctor will give you a prescription for this. You may need to take one iron tablet twice daily, starting one week before your first blood donation. Continue taking the iron until you come to the hospital. You can purchase the iron tablets over the counter at your local pharmacy without a prescription. We also recommend that you take one multivitamin daily during the two weeks before surgery.
Evening Before Your Surgery
It is important that you do not eat or drink anything after midnight the night before your surgery. If you are being admitted the morning of your surgery, do not eat any solid foods after 9 p.m., or drink any liquids, even water, after 12 midnight. You should also remove your rings, including wedding bands, the night before surgery, as your fingers may be swollen in the morning.
What to Bring to the Hospital
For your comfort, you will want to bring your own toiletries to the hospital. Also pack underwear and comfortable, loose pajamas or nightgowns. You will also need a robe (not floor length), and slippers or soft, low-heeled shoes with closed backs, such as sneakers, walking shoes or loafers. Please do not bring any valuables to the hospital. If you have equipment such as a walker, commode or long-handled reachers, you may want to have someone bring them in for you after surgery. If you do bring your own equipment to the hospital, please label the items with your name.
What to Expect in the Hospital Morning of Your Surgery
Most patients are admitted on the morning of surgery and should report to the Admission Unit, to be prepared for your surgery. Two visitors may come with you on the morning of your surgery.
To prepare for surgery, the nurse will ask you to remove your clothing (including underwear and socks) and to put on a hospital gown. In addition, you should remove any contact lenses, dentures, wigs, hairpins, jewelry, and artificial limbs. Please give these and other personal belongings to your visitors to hold while you are in surgery and until you are in your assigned room. You will be asked to go to the bathroom to empty your bladder before you leave your room.
An escort will transport you to the Operating Room on a stretcher about an hour before your surgery is scheduled. At that time, the nurse will direct your visitors to the Surgical Family Waiting Area where they can wait during your surgery. When the surgery is over, your doctor will phone your visitors there.
Before entering the Operating Room, an anesthesiologist will ask you a few questions and begin an intravenous line in your arm. Antibiotics will be started intravenously and continued after the operation to help decrease the risk of infection. Once you are in the Operating Room, you will be given the anesthesia that you and the anesthesiologist have discussed. Your surgery will take several hours. This period includes the skin preparation, positioning and anesthesia time. Some patients require spinal monitoring called somatosensory evoked potentials (SSEP) during the procedure to help protect their spinal cord and nerves during the operation. If you are having SSEP, a technician will place adhesive electrodes on your body.
After surgery you will awaken in the Post-Anesthesia Care Unit (PACU) or recovery room to recover from anesthesia. This usually takes an hour and a half to two hours. There, the nurse will frequently monitor your vital signs (heart rate, blood pressure, temperature and respiratory rate). The nurse will also be checking your dressing and the circulation as well as movement in your toes and legs. A surgical team member will tell your family when the surgery is over.
Hospital Care
Although each patient's procedure and recovery is different, the usual hospital stay for cervical spine surgery is one to two days. Most patients will be discharged home but some may go to a rehabilitation facility before returning to their home. Each patient will be evaluated during the hospital stay to determine if he or she needs rehabilitation. If you will be returning home, your doctor may ask the home care coordinator to arrange for a visiting nurse and/or therapist. If you will be going to a rehabilitation center, the social worker will coordinate your transfer.
The goal of your care after surgery is to help you become independent so you can return home.
By discharge, you should be able to : -
Get in and out of bed yourself
Walk in the hallway with or without a cane or walker
Climb stairs, if needed at home
Bathe and care for your personal hygiene
Understand all instructions for your recovery
To help you reach these goals, the staff will help you as needed, but they will also encourage you to actively participate and do as much for yourself. When you wake up after surgery, you will be in bed on your back, wearing a neck collar/brace. You will be helped in getting out of bed and will begin your activity program the evening of your surgery. The activity program includes leg exercises, walking, stair climbing, activities of daily living such as bathing and dressing and home management.
Cervical Spine Surgery: Recovery
After Your Surgery - Dressings
When you return from surgery, you will have a surgical dressing over your neck and hip (bone graft) incisions. The dressings will be removed several days after your surgery. You may have stitches (sutures) under your skin, which will dissolve as healing occurs. Some patients may have stitches (sutures) or staples that are visible. They are usually removed two to three weeks after surgery.
Keeping You Comfortable
The amount and type of pain you may have will vary and may be sharp, dull or achy. Before surgery, it is important to talk to your doctor and anesthesiologist about pain management. You may have burning or numbness and tingling feeling at your bone graft site. This can be relieved by walking and by applying ice or warm, moist compresses. Injections or pain pills will be available to relieve your pain. You should ask your nurse for medicine when your pain begins. If you feel that the medicine is not giving you relief, please talk with your doctor or nurse.
Intravenous (IV) Therapy
An intravenous line (IV) in your arm will give you fluid and nourishment. Once you resume eating and drinking, these IV fluids will be stopped. You will also have blood transfusions through the IV, if needed. You will receive an antibiotic through your IV every few hours for several days after your operation to prevent infection. The IV should not be painful. If it is, let your nurse know so that he or she can check it. Diet You will be allowed to eat and drink as tolerated. It is common to have a sore throat after surgery that may last for a few weeks. Drink fluids and eat soft foods, such as ice cream, yogurt and gelatin, to soothe your throat. Medications In addition to medications you were taking before surgery, laxatives and sleeping pills will be available to you if you need them. Please ask your nurse or doctor any questions or concerns you have about your medications.
Preventing Breathing Problems
It is important to practice deep breathing exercises after your surgery.
Place your hand on your stomach.
Breathe in through your nose.
Notice that your stomach rises and your chest expands.
Hold your breath for two seconds.
Breathe out through your mouth. Notice that your stomach goes down.
You should always cough following the deep breathing exercises. This will help clear your lungs.
Take several deep breaths.
On your next breath, breathe in through your nose and hold your breath for two seconds.
Then cough two or three times in a row.
You may need to do several "double coughs" to clear your lungs.
Your nurse will also teach you how to use an incentive spirometer, a device that helps you to breathe deeply. You should use this 10 times an hour while awake.
Preventing Circulation Problems
Maintaining good circulation in your legs after cervical spine surgery is very important. You can help your circulation by doing your leg exercises and walking. You will also wear sequential compression boots that automatically inflate and deflate, helping to pump the blood in your legs back up to your heart.
Activity Following Cervical Spine Surgery
Positioning
When you are in bed, the nurse will help you "logroll" from side to side as needed to prevent stiffness and promote good circulation. Logrolling is turning your hips, shoulders and neck at the same time without twisting your neck You should not lay on your stomach and you should not use the trapeze (triangle-shaped bar over your bed), as this will cause unnecessary strain on your back. You should ask for help when you feel ready to change your position.
Moving In and Out of Bed
On the evening of your surgery, the nurse will help get out of bed.
To get out of bed : -
Logroll to the edge of the bed.
Lower your feet over the edge of the bed and push on your elbow to get to a sitting position while keeping your back straight.
To get back in bed : -
Sit on the edge of the bed.
Lower yourself onto the bed on your side, corning down on your elbow. As you do this, lift your feet into the bed.
Once you are lying down you can logroll onto your back or other side.
Activity Out of Bed
It is good to take short walks in the hallway. You may need to use a cane or walker at first. If needed, a physical therapist will show you how to use the cane or walker and climb stairs.
Exercises
Your exercise program will vary depending upon what your doctor prescribes and your type of surgery. Your therapist will tell you which exercises you can do. You should do these exercises three times a day, in three sets of 10 each.
Ankle Pumps : - Lying on your back or sitting, move your ankles up and down as far as possible without moving your legs. This helps your circulation.
Quadriceps setting exercises : - Lying on your back, tighten your thigh muscle by pushing the back of your knee down on to the bed. Hold for a count of five seconds and relax.
Gluteal setting exercises : - Lying on your back, squeeze your buttocks together. Hold to the count of five and relax.
Neck Collar/Brace
Depending on your surgery and your doctor's orders, you may be asked to wear a soft cervical collar or a molded hard collar to stabilize your spine while the bone graft heals. The staff will teach you and your family how to correctly apply the collar/brace and how to care for it when you go home. Ask your doctor or nurse for specific instructions on when and how to wear the brace, and whether or not you can remove it to shower. At your first postoperative visit you will have an X-ray to check how your fusion is healing. If the doctor is satisfied with your progress, you can gradually wear the collar/brace less and less. Soon you won't need to wear it at all!
Some patients will need to wear a halo brace after surgery. It usually remains on for 6 to 12 weeks depending on the healing of fusion. You and your family will learn how to care for it before you go home.
Your doctor will determine how long you will need to wear the halo. When it is removed, you will be fitted for a hard collar and then eventually for a soft collar.
Discharge Instructions
Incision care
If you have visible sutures or staples, they will be removed about two weeks after surgery. Small pieces of paper tape, called Steri-Strips, will be placed over your incision. These strips will fall off on their own so do not pull them off, since this could disrupt your incision. If your doctor allows, you may shower and wash your incision with a mild soap and water and rinse thoroughly. However, you should not take tub baths, go in a swimming pool or immerse your incision in water in any way for 6 weeks. If you have a halo vest you should clean the pin sites with 1/2 strength hydrogen peroxide and salt-water solution, twice a day.
Activity
Activity is a very important part of your recovery. Since walking is the best way to recuperate and heal tissue, there are no restrictions for walking or stair climbing. You should not lift any objects heavier than 10 pounds, especially over your head, for the first four to six weeks at home.
You can sleep in any position that is comfortable for you, as long as your collar/brace is worn properly. Many patients find it comfortable to sleep in a reclining chair, or with a pillow under their shoulders, allowing their neck to extend into a comfortable position. You may not drive but you can take short rides as a passenger.
Neck Collar/Brace
If your doctor has ordered a collar/brace for you, you will receive specific instructions about its use before you leave the hospital. If you have a Philadelphia cervical collar, follow these steps to care for the skin under your collar.
To clean under your collar, have someone follow these steps when assisting you : -
Lie flat on your back.
Open the Velcro tabs on each side of the collar and remove the front part of the collar.
Keep your head still while the collar is open!
Gently wash and dry your neck. Inspect incision for signs of infection.
Replace the front part of the collar and fasten the Velcro tabs.
Turn to one side, with a thin pillow under your head and open one Velcro tab.
Gently wash the back of the neck and dry well.
Fasten the Velcro tab.
Turn to the other side and repeat.
Men should shave only with help while lying flat in bed. To do this, remove only the front part of the collar. Keep your head and neck still while shaving!
For comfort, you may find it helpful to place a silk scarf or a cotton handkerchief under the collar. Be sure there are no wrinkles.
If you have an Aspen collar, you may shower while wearing the collar. Then lie in bed and remove the collar so a family member can replace the foam pads. The soiled pads can be laundered.
If you have any problems with your collar/brace or feel it needs adjustment, call the orthotics facility where you were fitted before surgery.
Medications
A prescription for pain medication, if needed, will be provided when you leave the hospital. If you had a bone graft, do not take any non-steroidal anti-inflammatory medications for six weeks after surgery. Studies have shown that these medications can interfere with bone graft healing.
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