Cervical bk z 5/01 frc

SPECIFIC TOPICS
Returning Home After Surgery
Most patients who have had either an
anterior or a posterior cervical operative
procedure will leave the hospital a day or two after surgery. Withtheir neurosurgeon’s approval, they may return home even ifthey live a considerable distance away. Pain after cervical spinesurgery is usually treated with a combination of analgesics, suchas Darvocet, Vicodin, or other similar medications. Also musclerelaxants, such as Flexeril, are often used in addition to theanalgesics.
Fusion Patients
Patients who have had fusions are generally discouraged from
using anti-inflammatory medications because these tend to delay
fusion. If you are a smoker, you will have been strongly urged
by your surgeon to cease smoking. Medications (including
patches or Zyban) will be prescribed for you, if necessary, to
help you cease smoking during your recovery period. This is
essential because smokers have 25% less likelihood of a
successful fusion than non-smokers!
Applying Heat
Heat is often effective treatment following cervical surgery.
Applying heat by heating pad or warm towel several times a
day will bring comfort to virtually every patient who has had
a posterior surgical procedure and to some patients who have
experienced anterior cervical surgery. This heat relieves the
natural tightness that occurs during the postoperative period.
A dry covering should be placed over the incision while the
heat is applied.
Cervical Collar
If you have had a posterior operative procedure, you might be
prescribed a soft cervical collar. This is purely for your comfort
and should be discontinued as soon as possible. The purpose of
the collar is to help relax the muscles in the back of the neck by
keeping the chin up.
In general, the physicians at Front Range Center for Brain &Spine Surgery, P.C., discourage the routine use of cervical collars.
If you will recall your childhood, either you or your friends may have experienced a broken arm. If so, it was put in a cast thatwas probably removed in about six weeks. At that moment, you were no doubt surprised to see the loss of muscle that occurredthrough immobilization. We feel that by avoiding the cervicalcollar, patients reduce the degree of muscular degeneration.
Therefore we prescribe collars only when necessary forimmediate comfort or additional support. A neck brace or hard cervical collar is generally reserved
for a patient who has had fracture treatment and should be
worn until the surgeon directs that it be discontinued.
Length of Recovery Period
Patients who have had a posterior operative procedure without
fusion have one advantage over patients who have had anterior
procedures that include fusion. After the muscle spasm has
decreased for posterior, non-fusion patients, they do not have to
wait for the bone graft to fuse! Patients who have had anterior
procedures will have had bone grafts and plates employed and
will naturally have a period of of generally eight to ten weeks
while the bone itself heals. It should be noted that this does
not mean that the fusion patient will experience more discomfort
during healing than the non-fusion patient. Bone healing will
be ascertained by your surgeon through postoperative x-rays
at appropriate intervals. Usually, the first x-ray is taken about
eight weeks postoperatively. Only after receiving an OK during
a recovery checkup with your surgeon should an anterior
or posterior fusion patient begin some of the activities
listed below.
Postoperative Muscle Tightness
During the postoperative period, patients will no doubt
experience some muscular tightening. We advise patients
to begin gentle range-of-motion exercises—usually three
or four weeks postoperatively for fusion patients and as soon
as comfortable for patients who have had posterior, non-fusion
operations. These stretching exercises are designed to maintain
the tone of the muscles of the neck through some very mild
ligament stretching.
The Six Movements of the Neck
The human neck makes essentially six movements. All
movements of the neck are combinations and varying
percentages of these six movements. These gently performed
movements are:
1) flexion—the movement in which the chin is lowered down toward
the chest
2) extension—the neck is extended, as in looking upward toward
the ceiling
The above illustrations are excerpted from the Exercise and RehabilitationPrescription Kit. The illustrations are reprinted with the permission of the publisher:VHI Visual Health Information, P.O. Box 44646, Tacoma, WA 98444.
3 and 4) lateral rotation to the left and to the right—these are simply
direct lateral rotation to either side
5 and 6) lateral flexion may be best described as trying to place the ear
upon the shoulder through a sideways movement of the neck, directing
the ear toward the shoulder tip on both sides
These six movements may be slowly performed occasionally
to stretch the neck ligaments if they tend to feel tight. The
movements can be performed at any time by patients who
have not had fusions. If you have had a fusion, your surgeon
will discuss with you when you can start them.
It is important that the patient himself or herself initiate these
movements. Someone else should not grasp the patient’s head
and try to manipulate the neck in the above directions.
Tiredness After Surgery
You may have noticed, following your surgery, that you seem to
tire easily. This lack of endurance is common to all patients who
have had major operative procedures. Usually this is attributable
to general anesthesia and dissipates in one month. Walking or
similar aerobic activities can help patients regain their normal
energy.
Smoking
It has been mentioned above, but cannot be stressed enough, that
smoking will delay the healing of your incision. The anesthetic
will remain in your system for a longer time and you will
experience more fatigue if you continue to smoke postoperatively.
The use of appropriate medications, such as a nicotine patch or
the medication Zyban, are available to help you stop smoking
during the postoperative period and beyond. Of particular
importance is the fact that Zyban, if used, should be started
and used for two weeks before diminution of smoking is begun.
Nutrition
During recovery from surgery, good nutrition is critical. Eating
a well-balanced diet, a plan for which may be obtained from the
hospital dietary staff, is very important. You should not overeat
and gain weight. A daily multiple vitamin may also be helpful.
Car Riding and Driving
Car driving is of particular concern for patients who have had
cervical surgery. The rapid, brisk movements we make while
driving a car may be extremely uncomfortable during the first
few weeks after surgery. As a general rule, we have found that,
following neck surgery, it is more comfortable to be a passenger
in a car than to be the driver. Car trips should be quite short
for the first few weeks. If longer trips are contemplated out of
necessity, we suggest that your comfort may be enhanced by
the use of a soft cervical collar during the trip. We also suggest
that heat be applied to the muscles by means of a hot towel or
heating pad several times during the trip to help reduce some
of the muscle and ligament tightening.

Source: http://www.okneurospine.com/pdf/postOpCervical.pdf