POSTERIOR CERVICAL DECOMPRESSION AND FUSION
Posterior Cervical Fusion is a surgical procedure where the spine is accessed
through the back (posterior) of the neck. A “fusion” denotes the creation of one solid
bone between two adjoining vertebrae. A fusion is achieved with either a bone graft
taken from the pelvic bone (aka iliac crest), synthetic bone graft substitutes, and/or
bone morphogenic protein (BMP).
The procedure involves a midline incision in the neck through which the
musculature and soft tissue are retracted (aka moved). If decompression of a nerve is
needed, one of the following techniques is typically chosen:
Laminectomy – Removal of the posterior vertebral element.
Foraminotomy – Enlargement of the bony opening through which the nerve root
exits the spinal canal.
The spine is stabilized with either cables or screws and rods. The incision is then
closed with sutures. Average length of surgery varies from 2 to 3 hours, depending on the
number of levels.
Pre-operative testing and preparations
Prior to your surgery date, you will be required to undergo routine laboratory
tests, EKG and a chest x-ray. If you are over 50 years of age or have any history of
cardiac or pulmonary problems, you will also be required to have a clearance by a
cardiologist or pulmonologist, respectively. You will also be given information on what
medications, both prescription and over the counter, that need to be discontinued preoperatively
as many can interfere with wound healing and bleeding time.
What to expect in the hospital post-operatively
You will wake up in the recovery room after the operation is over. During this
time you may be disoriented and tired, which is the normal effects of the anesthesia
wearing off. Once stable, you will be taken to your room where you may be greeted by
friends and family. At this time your pain will be controlled by IV medications and
have a catheter placed into your bladder to drain urine. Your incision will be covered
by a sterile dressing which will stay in place for 2 to 3 days.
It is important to begin moving as soon as possible to prevent blood clots and speed your recovery. The day after surgery you will be visited by a physical therapist that will assist you. It is important to use your brace while out of bed. Over the course of your hospital stay, you will gradually increase your activity as tolerated.
Getting out of bed is also a very important step in helping your lung function return to normal. Areas of your lungs collapse during surgery and a couple of days post-operatively, which is known as “atelectasis”. Additionally, deep inspirations and the use of your "incentive spirometer” are essential.
You may shower after 2 days in the hospital, but it is important to keep the incision dry for 5 days. The nurse will cover your wound with Aquaguard to keep it dry or you may take a sponge bath.
Patients typically stay in the hospital for 2 to 3 days. Before your discharge, you will be provided with a list of “do’s and don’ts” and arrangements will be made for home health if necessary.
Once you arrive home
Continue to walk and slowly increase your activity level. Outpatient physical
therapy will begin after a minimum of four weeks
Sutures are removed 10 days after surgery.
You may shower, but do not soak in the bath or hot tub for 4 to 6 weeks.
Once the dressing is removed and you are informed to keep it open to the air,
make sure that you protect it from sun exposure. Once the incision is healed,
sunscreen should be on the incision for 6 months to one year. This will help
decrease its appearance.
Maintain a healthy diet, especially one that is high in dietary fiber to decrease constipation. Additionally, a diet rich in protein is ideal for the healing process.
Drink plenty of fluids.
Monitor your incision. It is common to have a small amount of blood and fluid
leakage, however, if there is persistent drainage contact the office. Additionally,
watch for opening of the incision, redness or warmth around the incision, or
fever greater than 101ºF.
No driving for 3 to 4 weeks or until advised.
No lifting greater than 10 pounds for 4 to 6 weeks.
No overhead activities with your arms.
Do not bend your neck forward or backward.
Do not take anti-inflammatory medications (i.e. Ibuprofen, Voltaren, Aleve,
Feldene, Lodine, Daypro, Naproxen, Naprosyn, Relafen, and Motrin) for 3
months after the surgery as this may inhibit bone fusion.
Smoking also interferes with bone fusion; therefore patients who smoke should
make every attempt to stop smoking before surgery. If you need additional
assistance, contact 1-800-NO-BUTTS for free information.
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