Post-operative instructions after anterior cervical decompression & fusion (ACDF)

Activity/limitations:

You may feel weak and tired for a couple of weeks after surgery. We encourage you to try to get back to your regular daily activities as soon as you can tolerate them. You may slowly do this but allow for rest periods throughout the day. Activity, especially walking around your home, is encouraged. Try to do so at least 4 times daily. Slowly increase the amount of your walk and use of arms every day. Do not stay in one position.

Do not do heavy housework, such as bed making, vacuuming or laundry. Limit your lifting, pushing heavy objects. If using stairs is necessary, go slowly and use the handrail. Do not lift anything over 10 pounds. Try not to minimize use of arms above shoulder level.

Other activities such as swimming, biking, etc. can be started any time after 4 weeks as long as you feel well while doing these activities.

We usually recommend starting formal active physiotherapy exercise about 4-6 weeks after uncomplicated neck surgery. This can be arranged through your family doctor on an outpatient basis if you already have not had this as part of your treatment prior to the surgery. Please be advised that OHIP will not cover the cost of this therapy.

Do not drive while you are taking narcotic pain medicine. In most cases, you can begin driving two weeks after surgery, but this is individually determined per patient and surgery.

Diet:

After anterior cervical spine surgery, it is very common to have a temporary sore throat or temporary difficulty swallowing. This occurs because your trachea ("windpipe") and esophagus (tube connecting mouth to stomach) lie in front of the spine and must gently be held aside during surgery. These symptoms gradually subside over a few weeks. Sometimes, the troubles with swallowing may persist for a lot longer after surgery, especially when eating dry foods or large pieces of meat that have not been thoroughly chewed. You can gradually resume your regular diet as you can tolerate.

Incision care:

The bandage will be taken off your neck before you go home at least once. We typically reapply a new bandage before the patient is discharged home. Usually the incision should no longer need to be covered after 2-3 days. Do not apply anything to incision unless instructed. Unless you were told otherwise prior to the discharge, you may take the dressing off in 2-3 days and wash/shower with mild soap. Small dots of dried blood or reddish-brown discharge is not uncommon after removing the dressing. You should avoid touching or rubbing the incision and do not soak in a bath for 2 weeks after surgery. You should dry your incision carefully after shower. You will need to purchase a staple remover when leaving the hospital. You should make an appointment to see your family doctor in about 7 days after discharge to have the staples taken out. This may vary in some patients and you will be given instruction if applicable prior to discharge.

Medications:

When you return home, you may continue to take your own medications unless your doctor tells you otherwise. You will likely have some pain/discomfort at the site of operation and mild swelling and redness around the incision at least for 1-2 weeks. After all surgeries, inflammation is a natural process of healing. We cannot and do not want to block this process. Please know that medication can take the "edge" off your pain, but we may not be able to stop all your pain. With each day that passes, you should get stronger and often times must simply be patient as the healing process begins. Feel encouraged by the "good days" as the "bad days" get further apart.

Some patients have neuropathic pain (typically continuous or episodic burning/ cold/tingling sensation} which has unpredictable resolution. Some patients experience immediate resolution, while in others it resolves over time, and yet others require additional medications or further injections to help their nerves settle down.

You will be given a prescription for pain medication, usually narcotic pain medicine, before you leave the hospital. Follow pharmacist's recommendation (and instruction on the label} when you pick up your medication. Your prescription is usually for 2 weeks supply. It is common to have constipation and slow bowel movement due to the effect of narcotic medication. It is important to drink lots of liquids and ingest lots of vegetables and fruits and maintain good mobility to minimize this condition. If you continue to have significant constipation, you may ask your family doctor for stool softener after 1-2 week while on narcotics.

Follow-up appointment:

Unless otherwise indicated at the time of discharge, your first post-operative appointment will be approximately 6-8 weeks following your surgery.

Return to work:

This may be different depending on many factors including degree of symptoms prior to surgery, patient's body response to surgery and type of work. Generally speaking most patients can return to work about 6 weeks after surgery. This should occur in graded fashion and with gradually increasing hour as per the patient's tolerance. There is no rigid rule or recommendation for working after this timeline.

Remember:

Call our office at 416-480-5263 if you:

• Have a large amount of drainage, bleeding and/or odor from your wound.
• Have increased redness/swelling at the incision site associated with unexplained increasing incisional pain.
• Have persistent fever greater than 38.5 C with sweats or chills.
• Have new or unfamiliar weakness in the arms or legs.