Anterior Cervical Surgery - Post-op Instructions

Wound care

• Keep incision dry and uncovered
• Always wash hands thoroughly before touching your incision
• Outside of necessary wound care, avoid touching, rubbing, or patting your incision.
• Your incision is likely covered with skin glue. This may begin to peel back on its own. If so, do not forcefully remove. Allow it to come off on its own. You may trim any hanging glue with clean scissors if needed.
• Ointments and creams are NOT necessary, however you may begin applying topical Vitamin C to the incision starting 2 weeks after surgery to enhance healing and minimize scar tissue
• Clean the skin around the incision each morning and night with either 2% CHG (chlorhexidine) wipes or a CLEAN washcloth, warm water, and mild soap

Activity

• If involved in physical therapy, continue regimen as prescribed by physical therapist
• If physically able, 30-60 minutes of walking should be done daily, but not all at once. Divide your walks into intervals of 10-15 minute walks at a time. Have someone accompany you for the first few times until you feel comfortable.
• Avoid lifting anything greater than 5 lbs (about a gallon of milk) for the first 2 weeks, and 10lbs between 2-6 weeks after surgery . After 12 weeks, you may lift up to 30 pounds.
• This means NO household chores such as laundry, physical hobbies such as golfing, hunting/shooting, or yard work for the first 6 weeks
• If you have young children or grandchildren, do NOT pick them up for the first 6 weeks
• Do NOT allow pets in the bed with you or near the incision. Wash hands thoroughly after petting/caring for any animals
• We generally recommend sleeping slightly propped up to help with any swelling for the first 2 weeks
• The only sleeping position prohibited is belly sleeping. If you are a side sleeper, invest in a knee pillow and good supportive head pillow that will keep your spine in neutral alignment
• You may drive as long as you are not taking narcotic pain medication and can check your blind spots despite your cervical collar in place. It is generally recommended to have someone drive you for the first 2 weeks
• It is ok to ride as a passenger if you are taking narcotic pain medication.
• Return to work will depend on the type of surgery and what work you did prior to surgery. Do not return to work until cleared by the office.

Cervical collars (braces) & Bone Stimulators

• Collars are prescribed commonly for fusion procedures to immobilize the spine and promote healing and bony fusion at the surgical levels
• Collars are generally used for the first 6 weeks after surgery, but may be used longer if needed
• Your collar will be given to you after surgery before leaving the hospital
• If prescribed a hard collar, you may sleep in a soft collar
• While collars can be uncomfortable, compliance is crucial for optimal recovery
• If you were prescribed a bone stimulator, a company representative will be reaching out to you to provide the device and instruct on use. Generally, these are worn for 4 hours a day (may be broken up or all at once) for anywhere between 6 months and 1 year. Bone stimulators have been shown to increase bone healing/fusion in at risk patients

Tobacco

• Avoid smoking/vaping, as this restricts the blood flow of oxygen and nutrients to the wound and bones, leading to delayed wound healing and increased risk of infection after surgery
• Multiple studies have established that patients who smoke have a significantly increased risk of hardware failure, absent bony fusion, and other complications after a fusion procedure
• Carefully consider quitting smoking during this time. If you need help quitting smoking, contact your primary care physician.

Medications

• Completely finish any steroid (Medrol, methylprednisolone), if prescribed. Be sure to take an acid blocker (Pepcid, Preavid, Tums, etc.) while on steroids to prevent heartburn. Take with food.
• If prescribed an antibiotic or steroid, start this on the first morning you are home
• Avoid blood thinners (Aspirin, Plavix, Coumadin, Eliquis, etc.) until cleared by the office (typically allowed to restart on 5th day after surgery)
• Take pain medication only as directed. You should begin to wean the amount and frequency of pain medications you take every couple of days or so
• Ice packs may be applied to incision as needed for swelling
• Take pain medication with food to minimize any associated nausea
• Avoid NSAIDs (Ibuprofen, Aleve) and aspirin, BC powder, or other aspirin containing products for pain during the 6 weeks after surgery
• Be sure to take a gentle over the counter laxative (Colace, etc) while taking pain medication to prevent constipation. Walking will also help with this.
• Take a general multivitamin daily for at least the first 6 weeks after surgery
• For any refill requests, call the office in advance only during regular office hours. Please allow at least one business day for medication refills.
• If taking a GLP-agonist such as Ozempic, Mounjaro, Zepbound, Wegovy etc., you no longer have to skip doses before surgery, but you MUST start a full liquid diet for the day prior to surgery. If you do not comply, there is a possibility your surgery will be cancelled. It is recommended to still delay restarting these medications until 5-7 days after surgery.

Diet

• Eating and swallowing after anterior neck surgery can be painful and difficult at first. This is normal and a sore throat is expected for several weeks. It is recommended that you try liquids and soft foods at first, advance to regular foods as tolerated. Use caution with bread, crunchy foods, and less tender meats such as beef/pork. Avoid overly hot coffee/tea
• If diabetic, continue strict diabetic diet adherence to promote healthy wound healing and bone healing
• Be sure to eat a diet high in fiber or take a fiber supplement
• Ensure adequate protein intake. BOOST and Ensure drinks are simple solutions to ensure adequate protein intake, if needed.
• For any postoperative nausea. You may follow a “BRAT” diet (Bananas, Rice, Applesauce, Toast) if needed and advance diet as tolerated
• Avoid alcohol

When to call office

• Any drainage from incision or increasing redness.  Fever greater than 101.4
• Increasing neck swelling or trouble breathing
• Increasing arm or leg weakness, or loss of control of bowels or bladder
• Calf tenderness or swelling, chest pain, shortness of breath, burning with urination
• Constipation not alleviated by over the counter laxatives or suppositories/enemas

Expectations

While we wish every patient a speedy recovery, remember that recovery from spine surgery is complex and often not predictable. Rest assured that if you were offered surgery, it is because we expect you to see significant improvements.

However, please keep in mind that oftentimes your pre-operative symptoms will be exacerbated for the first several weeks after surgery due to inflammation and realignment. Pain is expected and normal for the first several weeks. Full recovery and nerve healing may take up to 1 to 1.5 years.