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Introduction

This booklet contains general advice to help you to help yourself (and your friends and relatives) during your convalescence. If it raises any worries or concerns, please ask. When home, keep it handy for future reference.

Doctors, therapists and nursing staff are here to help you and your questions are welcomed and encouraged.

Remember, the most important member of the health care team looking after your neck is YOU!

• Your spine is the central support for the entire body and is involved in almost all your movements.
• The vertebrae are the joints of the spine. They surround and support the spinal cord and the nerve fibres, which relay messages from and to the brain from all parts of the body.
• Muscles attach to the bony edges of the vertebrae
• The vertebrae are connected by the intervertebral discs, a pad of cartilage which acts as a shock absorber
• The spine is not rigid, it can bend and rotate
• The most mobile areas are the neck and lower back
• It is this mobility that allows ease of walking, lifting and reaching

Operations

There are several types of operations that can be performed on the spine, depending on the cause of symptoms. Your surgeon will explain your operation to you. The most common operations are listed below:

• Anterior cervical  decompression & fusion This operation involves the

removal of an intervertebral

disc & replacing it with a cage or a bone graft to fuse

together & stop movement at the joint. Metal screws + plates are sometimes used to provide stability.

Corpectomy

This operation involves the removal of all or part of the vertebral body. This is then replaced with a bone graft to provide stability.

Foraminotomy

This operation involves the removal of part of the intervertebral disc. To make more space for the spinal nerves.

Laminectomy

This operation involves the removal of the arches of bone at the back of the spine, usually over a number of spinal segments. By doing this the spinal canal gains more space.

Posture

After your neck surgery you may notice stiffness and some pain in your neck. This could be associated with the wound but also muscle spasm and poor posture that is usually linked with neck pain.

Achieving good posture requires practice however it can reduce your levels of pain. You may choose to use supports or neck rolls to aid your posture however ensuring that your neck stays mobile by moving it regulary to prevent neck spasm. Your physiotherapist will advise you of these exercises.

The first post-operative day

1.Breathing Exercises

Due to the effect of the general anaesthetic, there may be some, or an increase of, phlegm in your lungs. Take three or four deep breaths every one to two hours then have a cough and try to clear any phlegm.

Drugs

Painkillers will be prescribed for your immediate postoperative period. They are the most effective when taken regularly or when you start to notice discomfort or pain. If you wait until your pain gets unbearable you may experience unnecessary discomfort. Remember that they should be taken to allow you to MOVE with minimum discomfort.

Positioning

There is not one specific position that is recommended and you may find sitting for long periods uncomfortable. You should therefore change position regularly to include sitting, standing, lying and walking.

Sleeping with only one pillow is the recommended sleeping position as it enables your spine to be straight.

However if you are more comfortable with more pillows, feel free to do so.

Walking

Short walks will probably be your main source of exercise in the early days. Regular short walks are better than one long walk.

Gradually increase the number and length of your walks as advised by your Physiotherapist.  When returning to base, if your back aches you may wish to lie down otherwise have a short rest in sitting.

Flying

You will need to first check with your airline prior to flying especially if you’re wearing a collar.

We recommend that you wait at least 2 weeks post op before flyimg but if in doubt discuss with yor consultant.

Functional Activities Of Daily Living

With thought and planning all your everyday activities are achievable post-surgery.                   Indeed, it is considered the best form of exercise to aid your recovery.

Here are some suggestions you may find useful:

Bathroom and Personal Care Activities

• Strip washing and showering are preferable to bathing for the first 3 weeks following surgery.
• Consider sitting on a stool at the washbasin or if standing, bend at the knees rather than stooping forwards for prolonged periods. Alternatively, put one foot in front of   the other and place one hand on the surface in front of you.
• If you feel you have or will have difficulties with the above at home please alert a therapist who will advise you further

Kitchen activities

• Arrange your most frequently used items between waist and eye level to reduce the need for reaching and bending.
• Kneel to reach into lower cupboards, washing machines, dishwashers or ovens.
• Sit down for lengthy jobs such as preparing vegetables or ironing to prevent neck strain and poor posture.
• Alternate between sitting or standing when preparing meals.
• If your sink is low, consider raising the height of the bowl by using the draining board or by upturning another bowl to rest on.

Household Chores

Cleaning

You may carry out light housework as your comfort allows.

• Avoid vacuuming for the first 4 weeks.
• Use, where possible, long handled brushes.
• Get help to carry heavy buckets or vacuums.
• Always kneel to clean the bath.

Making the bed

• Always kneel to make the bed, maintaining good posture.
• Avoid overstretching.
• Use quilts/duvets to avoid heavy blankets or bedspreads.
• Enlist help wherever you can.

Laundry

• When hanging out washing, bring the line down to head height.
• Do not look up for too long.
• Make several light trips from machine to basket to line, ensuring good posture throughout.
• Do not carry a full basket of laundry.
• Iron in short sessions, not all at once.
• Enlist help.

Shopping

• Carry a small bag in each hand, not one large one.
• Shop more frequently for small amounts.
• Use the trolley right to the car to avoid carrying heavy, awkward bags.
• Enlist help.

Driving

• Ensure seat is in a comfortable position.
• Before returning to driving you should be able to get in and out of the car comfortably.
• You must be able to look behind you and see your blind spot safely, complete an emergency stop (most people should be able to do this at around 3 - 4 weeks, some even earlier).
• Do not drive for any longer than you can comfortably sit.
• If you have a driving based occupation then you should not return before 4-6 weeks, particularly if it involves long distances.
• If you have to wear a collar post-surgery then you should not drive until you have been allowed to remove it.

Wound Care

• Your nurse will be able to provide you with accurate information regarding care of your wound.
• In general stitches or clips will need to come out at 7-10 days post-operation. This can be done at your GP Surgery.
• You may be informed that you have dissolvable stitches - in which case these will just dissolve and therefore do not require removal.
• You will need to keep the wound clean and dry whilst it is healing. You will be provided with waterproof dressings that can be used in the shower. Do not have a bath until the wound is healed.

Contact your GP if any increased swelling, redness or wound leakage develops.

Going Home

Start off with the little things you can manage easily and plan to gradually increase your activity over the coming weeks.

Your GP can offer treatment, information and support on all medical matters following your discharge from hospital.

Most patients do not require follow up therapy, however if you require further therapy on discharge, this will be discussed with you individually, during your stay and arranged as necessary.

Please be aware that each area has its own waiting list. You may have to wait for 8 weeks for a follow up appointment.

Key Points To Remember

1.Lifting

• You should avoid any heavy lifting for the first 12 weeks. Half a kettle is probably as much as you should lift within the first 12 weeks. From then, aim to gradually increase to slightly heavier objects.
• Assess whether the lifting task is necessary.
• Do not twist whilst lifting.
• Avoid lifting above shoulder level.
• Hold object close to your body.
• Do not lift if it causes discomfort in your neck.
• If the lifting increases your pain then STOP.
• Try to avoid lifting and carrying children unless absolutely necessary.

2.Hobbies

Research evidence suggests that best results are achieved from returning to your normal activities (being aware of neck care) at the earliest opportunity, as you feel able.

Gardening - Aim to return to light gardening around 12 weeks post- operation. Try to minimise any prolonged bending and be careful when lifting and twisting.

Walking the dog - This should ideally be avoided for 12 weeks, particularly if using a lead as any sharp jerks may pull your neck and cause further discomfort.

3.Swimming

Swimming is a fantastic exercise to return to following surgery as it strengthens large groups of muscles that support the spine whilst reducing load from your joints to make exercise more comfortable.

You may return as soon as your wound is healed and dry. This is usually around 4-6 weeks, unless you have been advised to wear a collar. In which case do not swim until advised by your doctor.

4.Sports

You will be able to return to most sports as is comfortable and in general, exercise is good for your back. However some sports (e.g. contact sports/weight lifting) may put an increased strain through your spine making a recurrence of injury more likely. Many patients decide to change their lifestyle after surgery to prevent future problems.

Specific advice individual to you can be discussed with your medical team as it can change dependent on the type of surgery and previous level of function.