Understanding Rehabilitation and Care Following Anterior Cervical Fusion

Article written by Larry Kurz, MD

WOUND CARE
Most wounds are closed with absorbable stitches which do not need to be removed. Multiple tiny strips of tape are placed along the wound edges to keep the edges closed during the rest of the wound healing. The strips should be allowed to fall off on their own. The wound may get wet during bathing and should be patted dry with a clean towel. If the wound is draining bloody or blood-tinged fluid, the dressing should be changed as frequently as it gets soiled. Any drainage for more than 1 or 2 days, or any signs of infection, should be discussed with your surgeon promptly.

MOVEMENT
You should have in mind that the muscles, deep stitches and other soft tissues all take at least 6 weeks to heal. Therefore, neck movements should be watched quite carefully to avoid injuring your surgeon’s handiwork. Although sitting, standing, walking and lying down are usually acceptable positions/activities, you should avoid any movements which are repetitive, or sudden. In general, climbing ladders should be avoided. Climbing stairs, one at a time, is usually permitted. These restrictions apply up to 6 weeks after surgery. However, leaning over a sink to brush teeth, or wash-up, is permitted, even within a few days after surgery.

DRESSING
This activity is permitted provided the restrictions of movement, as outlined above, are observed.

LIFTING
A gallon of milk weighs approximately 8 pounds. This weight should be your maximum lift for the first 6 weeks. Be sure to keep the item as close to your body as possible. Heavy lifting or reaching over your head should also be avoided for the first 6 weeks.

EXERCISE
Permitted exercise, during the first 6 weeks involves walking on level ground. Following this, you may go in a swimming pool, although swimming with repetitive neck turning movements should be avoided for 3 months. Jumping, diving and kick turns or flips should be avoided as well. Use of a stationary bicycle, regular bicycle, stair-climber, weight machines, and elliptical machines may be used after 6 weeks. However, sit-ups should be avoided until instructed otherwise by your surgeon or physical therapist.

BATHING
Because of the excessive stresses placed on your neck during entering and exiting a bathtub, it is recommended that only showers be taken during the first 2 weeks following surgery. Sitting on a shower-seat is advantageous as it decreases the chance of slipping or falling.

NUTRITION
Although the ability of a patient to form an adequate spinal fusion is based on many factors, few are as important as adequate nutrition. In order for the bone to grow into a solid fusion between the 2 vertebra, it requires protein, and a lot of it. The fusion gets the protein from only 2 possible sources: food and drinks, or from the breakdown of muscles into protein-forming building blocks. If you do not provide the fusion with adequate protein, in the form of food and drinks, it will rob your muscles of the protein it needs to function, and your fatigue will increase. Therefore, you must increase your protein intake during at least the first 4 months after the surgery. Protein-rich foods should be stressed. Any, or all of the following, should be considered: Dairy products, fish, eggs, chicken, turkey, and red meats. Of course, the healing fusion also needs increased calories in general, so you should still eat a balanced diet. Your appetite is typically diminished for a period of time following surgery, and your intake of vitamins (that are contained in that food) is also diminished. Supplemental vitamins may be helpful in providing needed factors which are helpful in healing your fusion.

BRACE
The advent of technological advances in instrumentation systems has diminished the need for external immobilization of the neck. However, if your surgeon gives you a neck collar to wear, it usually may be removed for showers and sleep. Soft collars are typically worn only for comfort, and only 1 week or so. Hard collars provide more support, and usually are worn for 4-12 weeks, especially in patients who have specific indications for a longer immobilization period.

DRIVING
Driving is usually permitted by 1-2 weeks following surgery if there is no collar to be worn. However, if your surgeon requires you to wear a hard collar for a longer period of time, there may be some reasons not to drive yourself. Turning your neck will be difficult, and turning your body, instead, may be dangerous.

MEDICATIONS / PAIN PILLS
The spinal fusion process is adversely affected by certain medications, and unless absolutely necessary, they should not be taken for at least 6 months following surgery: Oral cortisone preparations, and non-steroidal anti-inflammatory medications such as ibuprofen, Aleve, aspirin, Motrin and Advil. Some patients require narcotic medications for up to a few weeks after surgery. These medications should be weaned as pain diminishes.

OFFICE VISITS
Your surgeon will want a number of follow-up visits in the office in order to assess your progress, as well as to take and review x-rays to assess the progress of the spinal fusion.

METAL DETECTORS
Most spinal instrumentation is made of titanium. This metal is not usually detected by commercial metal detectors such as those in airports.

SMOKING
Cigarette smoking is detrimental to your spinal fusion, and prevents its formation. Cigarette smoking, and second hand smoke, is not permitted until your surgeon tells you that your fusion is solid. This rarely occurs before 6 months after the surgery.

FATIGUE
Most patients feel fatigued, sometimes to the point of exhaustion for up to 4 months after surgery. This is usually due to deconditioning, and, in some cases, due to anemia and some situational depression. These symptoms usually resolve.

WEIGHT LOSS / GAIN
It is common for patients to lose or gain weight in the first few months after surgery. This is a balance between weight loss from diminished calorie intake due to poor appetite, and weight gain from diminished activity. With time, weight can increase from improved appetite, and can decrease from increased activity, especially beginning with physical therapy.

PHYSICAL THERAPY
Physical therapy typically begins 4 weeks to 3 months after surgery, and usually lasts 6-12 weeks. Initially, stretching exercises are performed to provide flexibility. This is usually followed by aerobic exercises to improve body conditioning. Resistance training with weights, improves strength and stability to the body, and especially the neck. Maintenance programs are key in maximizing your result.

RECREATIONAL ACTIVITIES
Restricted or unlimited participation in sports activities are variably permitted by your surgeon after the fusion has healed.