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.

1. 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.

2. 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!

3. 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.

You can apply ice or warm, moist compresses to your bone graft site and/or shoulders to alleviate soreness.

To learn about Dr. Albert’s practice, click here.

Authors:
Rothman Institute
Department of Home Healthcare
Department of Nursing
Department of Orthopaedic Surgery
Department of Rehabilitation Medicine