Cervical Spine Discharge Instructions

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1 Pain After surgery you may experience pain in the region of the incision. Some neck and arm pain as well as tingling or numbness may also be present. Initially it may be of greater intensity than pre-operatively, but will subside over time as the healing process occurs. This discomfort is caused from surgical retraction of tissue as well as inflammation and swelling of the previously compressed nerves. Some patients experience a sore throat and swallowing difficulty after general anesthesia and surgery. This is from manipulation of tissue and the presence of the breathing tube for anesthesia. The sore throat usually will subside within a week. The swallowing difficulty may take longer up to a year. Using throat lozenges or lemon drops, sipping cool liquids, or sucking ice chips may soothe this pain. Wound Care You may remove the dressing 5 days after surgery. Apply a dry dressing if there is any drainage. You may also apply a dressing if the brace or your clothing irritate the incision. You may shower after 5 days if your incision is no longer draining. Do not rub the incision, let the water run off and blot dry. No soaking in a bath tub, swimming pool, lake, or hot tub for 3 weeks from your date of surgery. No lotions or ointments on incision until completely healed (approximately 4 weeks). Steri-Strips usually fall off on their own, they may be removed 2 weeks after your surgery date if they do not. Activities You may drive a car once you are no longer using pain medications and when you feel you can safely control a car, usually 2-4 weeks. You may want to check with your insurance company to make sure they have no restrictions related to returning to driving. Once you are comfortable you may again become involved in sexual activity. Physical therapy, if needed, will be prescribed at approximately 6 weeks. You may walk for exercise but follow the restrictions noted below. Diet Most people can resume their normal diet after discharge. You should eat well balanced meals to encourage good health and good healing. Page 1

2 Depending on your surgery, you may experience difficulty swallowing for up to a year. If you have severe difficulty swallowing any foods while at home, please contact the office. Restrictions Wear your Ted stockings for at least the first two weeks after leaving the hospital. If your legs continue to swell wear the stockings for 4 more weeks. You may remove the stockings when your legs are elevated or in bed. You may wash the Ted hose in the sink or washing machine, but let them air dry. No lifting > 10 pounds until seen back in the office at 2 weeks. (A gallon of milk is 9 pounds). Limit twisting, bending, stooping until seen back at follow up. Move with your shoulders and hips together. Roll like a log when turning in bed. No excessive flexion/extension (nodding motion), side bending (ear to shoulder), or excessive rotation (as if saying no) of the neck. Turn your body when looking from side to side. No extra pillows when sleeping. Try to use a flat pillow or small blanket for your headrest. No driving while using narcotic pain medication. Do not take any type of anti-inflammatory medicine for the first 6 months after the surgery ( Advil, Motrin, Ibuprofen, Aleve, Naproxen, Indocin, Celebrex). These medications inhibit the development of bone to form a solid fusion. If you have any questions about your medications please call us. You may use ES Tylenol as needed, but do not consume greater than 4000 mg or 4 grams of Tylenol in a 24 hour period of time. Please include the Tylenol in pain medications in the 4000 mgs. You may call us if you need more prescription pain medications. When you leave the hospital you will be on prescription pain medication for approximately 2 weeks. After 2 weeks we may give you more pain medication if needed. Please call for medication refills by Thursday of the week, so they are able to get filled prior to the weekend. Cervical Bracing Wear you collar or brace 23 hours per day until follow-up. Only remove brace to shower and then reapply it. You need to sleep in your brace. The collar is to be worn for 6 weeks after surgery or as designated by Dr. Hsu. Page 2

3 We will advise you when its use may be discontinued. The collar should fit snugly, yet comfortably. It should allow only minimal motion. Do not fight the collar; cooperate with it. This will assist in bone healing and minimize neck discomfort and skin irritation. Therapy There is no formal physical therapy program until 6 weeks if needed. Take small frequent walks in or outside your house when you go home. Gradually build up your walks to 15 minutes every hour. By your 3 month visit you should be able to walk 20 minutes or 2 miles. Use common sense when returning to activities, if it hurts do not push past this point, slow down. Call us before starting any type of sports programs or aerobic programs. Complications Do not smoke. Smoking decreases the chance of a solid boney fusion and post-op improvement. Complications occur and we need to know about them. Please call if you have a fever (greater than 38.5C/101.4F); drainage from your wound; increased incisional pain; new numbness or tingling not present before you left the hospital. Also call us if you experience loss of bowel or bladder control; increased warmth or redness at the incision sight; excessive vomiting, chills, night sweats, or severe headache when sitting or standing. Follow-up A follow-up appointment has been set up from your previous office visit. If this has not been done or you are unsure of the date, please call us when you have been discharged from the hospital. Dr. Hsu generally likes to see you 2 weeks after surgery. If there are any questions, please do not hesitate to call during business hours 8:30 AM to 4:30 PM. If there is an urgent call, there is somebody on call after hours as well. If there is a true emergency, dial 911. Page 3

4 Medications Narcotic pain medication will be available for pain relief after surgery. Narcotics are very effective for pain relief but may cause other side effects. The possible effects vary among patients and may include: sleepiness, nausea, constipation, flushing, sweating, and occasionally euphoria or confused feelings. If you have any adverse side effects, please call the office or go to the emergency room Norco-10 mg. 1-2 tablets by mouth every 4-6 hours for pain Percocet 325/5 mg. 1-2 tablets by mouth every 4-6 hours for pain Phenergan 25 mg. 1 tablet by mouth every 6 hours to help pain meds Ativan 1 mg. 1 tablet by mouth three times a day for spasms Bowel and Bladder Function During surgery you may have a catheter (tube) in your bladder to monitor your urine output. Upon its removal you may feel a stinging sensation for 2 to 3 days, which is normal. Some patients may have difficulty urinating after surgery. If this occurs, notify us immediately, you may need to be seen in the office or emergency room and may even require a catheter in your bladder. After surgery, constipation frequently occurs from inactivity and the side effects of pain medication. Stool softeners and laxatives will be available. Respiratory Hygiene Deep breathing is very important after surgery to maintain lung expansion and reduce the risk of pneumonia. At the hospital, you will be provided with an incentive spirometer and instructed about its use. This device should be used every 15 to 30 minutes during your wakeful hours initially, then every 1 to 2 hours as your activity returns to normal. This device is yours to take home. Continue to use it at home for at least 1 week after your discharge. Smoking is absolutely forbidden. There is clear evidence that smoking dramatically increases your risk of post-operative complications. There is also evidence that smoking adversely effects bone healing and nerve recovery. Second hand smoke also applies, so family members and friends should avoid smoking while around you. Page 4

5 Home Activity Your recovery is an essential part of your surgical process. Following these guidelines and the instructions given to you by your physician and nurse will provide you with the best opportunity to return to your desired activities as completely as possible. The First Week Early to bed, late to rise and frequent rest periods throughout the day. Get at least 8 hours of sleep each night. A disrupted sleep pattern is common after discharge from the hospital and will return to normal over time. You may not drive, but you may be driven, for short distances, using proper restraints such as shoulder and lap belts. May climb stairs with hand rail Begin a daily walking program with 1 to 2 blocks initially; schedule a daily time and increase distance daily. Eat a regular, balanced diet. Take medications as prescribed, using narcotics as needed. Practice good neck posture and wear your collar as instructed. The Second Week Resume normal rising and retiring schedule, but continue to rest throughout the day. You may not drive. May climb stairs with hand rail Continue scheduled walking, increasing distance and frequency as able. May resume sexual relations when comfortable. Begin narcotic weaning as pain diminishes, relying mainly on nonnarcotic medications Follow-up in the office with your physician for further instructions. The Third through Sixth Week Resume normal rising and retiring schedule, resting as needed. May resume light work around the home; lifting not to exceed 20 pounds. Continue scheduled walking. Ask about driving at this point. You may not drive while on pain medications. Follow up after 6 weeks for further instructions.. Disability The usual period of recovery for cervical disc surgery is 8 to 12 weeks and complete healing may take from 3 to 6 months. Some patients may return to work sooner than others depending on their job, response to surgery, and ability to perform other lighter tasks in the work place. Physician approval is required prior to returning to work. Page 5