I. Post-operative day 1.
1. Recuperation position.
Anterior cervical spine: bed rest with the head of the bed elevated by 30-40°, which is conducive to reducing blood leakage from the incision. Change the position appropriately every 2 hours to prevent pressure decubitus ulcers. You can lie on your back or side, and keep the pillow at the same height as your shoulder when lying on your side, with the cervical spine in a natural straight and neutral position.
Posterior cervical spine: supine and lateral lying is possible. Special attention must be paid to not compressing the posterior cervical region in the supine position and not padding the neck with pillows, towels, etc. The lateral position is recommended to avoid problems with the posterior cervical wound as well as internal structures due to compression, which can affect the surgical outcome. It also prevents the incisional drainage tube from being compressed, which may lead to the accumulation of blood in the wound and the occurrence of accidents.
The pillow should be kept at the same height as the shoulder when lying on the side. Too high or too low pillow can cause strong discomfort and even pain due to neck distortion. For back hunchback deformity, the side lying position is preferred. When lying on your back, you should pay attention to adjust the height of the pillow on the back of your neck. Change the position every 2 hours to prevent the formation of pressure ulcers.
After complete awakening from general anesthesia, regardless of anterior cervical spine surgery or posterior cervical spine surgery, as long as there is no obvious pain, under the guidance and assistance of the doctor, the patient can sit up and walk away from the bed on the day of surgery, and can support the toddler frame to keep walking smoothly. Generally, the standing position is more conducive to reducing spinal edema, reducing venous stasis and promoting blood circulation than the lying position.
2. Neck braking: Wear a neck brace to limit neck movement and avoid cervical extension and rotation, including head twisting and nodding. Pay attention to keep the neck neutral and upright when turning, but avoid twisting the neck.
3.Diet: 4-6 hours after waking up from general anesthesia, you can eat water, with easily digestible liquid food and semi-liquid food as the main food.
4.Postoperative pain relief: the pain of anterior cervical spine surgery incision is generally mild and can be treated with simple symptomatic treatment, mostly without pain pump. A part of posterior cervical spine surgery will have obvious incision pain, which requires special analgesic treatment.
5.Focused observation: vital signs, airway, drainage tube and nerve function of the extremities. Cardiac monitoring – observe blood pressure, pulse, heart rate, oxygen saturation and other important vital signs.
Respiratory tract – Observe for sore throat, chest tightness, breath-holding, dyspnea, etc. The relatively mild ones can be treated with nebulized inhalation and oxygen, and most of them are relieved in 2-3 days. Pay attention to the hematoma compression of the airway – asphyxiation death, vegetative.
Drainage tube – need to observe whether it is smooth, how much drainage; if the negative pressure suction device is almost completely inflated because of the accumulation of more old blood or gas, timely treatment to avoid excessive blood retention in the wound causing hematoma or cause infection. The drainage tube needs to be readjusted if necessary.
Neurological function – Observe the sensory-motor function of the extremities. Every half hour, ask to observe the sensory-motor condition of the upper and lower extremities of the hands and feet. If the numbness worsens and the range expands, especially if the strength and range of motion of the lower extremities decreases, the health care provider needs to be informed promptly. Epidural hematoma – quadriplegia or start as paraplegia, 3/1000.
Second, postoperative day 2-3 (24-72 hours).
1. Position and neck braking: you can wear a neck brace to get up on your side and move away from the bed. You can use the walker to practice walking first, and then gradually walk normally, but should avoid cervical extension and flexion, rotation, including twisting and nodding the head.
2, diet: easy to digest semi-liquid food is the main, if there is no sore throat and other discomfort, you can eat normally. Eat more food with high calcium, high vitamin and high protein to promote wound healing.
3.Drainage tube: Generally the 24-hour drainage flow is less than 50 ml, consider whether to remove the drainage tube according to the condition.
4, cardiac monitoring: if blood pressure, pulse, heart rate, oxygen saturation and other important vital signs are stable, they can be removed the day after surgery.
5.Respiratory tract: you can continue with nebulized inhalation to reduce respiratory symptoms. Pay attention to pulmonary atelectasis, pneumonia; pulmonary artery embolism (0.9%~14%), hypoxemia, and respiratory failure.
6, neurological function: continue to observe the sensory-motor function of the extremities, especially 3-4 hours after removal of the drainage tube. Pay attention to the experience of observing the sensory-motor function of the extremities and the change of symptoms such as dizziness and headache, panic and chest tightness, nausea and vomiting from the preoperative period, and communicate with the doctor in a timely manner.
7. Review the cervical front and lateral X-ray to observe the cervical spine sequence and the position of bone graft and plate screw.
III. Postoperative days 4-7.
Wear a neck brace when getting up, get up on your side, and you can do some auxiliary functional exercises for your limbs.
During this period, postoperative cervical spine CT and MRI examinations can be done to better understand your condition and judge the effect of surgery, so as to facilitate later rehabilitation and re-examination.
Discharge from the hospital is usually arranged at 4-7 days after surgery. Those with intracutaneous cosmetic sutures do not need to remove the sutures; for those with general silk sutures, the sutures are removed one week after the anterior cervical approach and 12 days after the posterior cervical approach, which can be removed at outpatient clinics or community hospitals.
IV. 4-6 weeks after surgery.
If there are no special circumstances and the surgery and postoperative recovery are smooth, it is generally planned to wear a neck brace for one month after surgery. You can resume office work 3 weeks after surgery. Within 4-6 weeks after surgery, it is necessary to wear a collar in daily life and when going out and riding in a car to protect the cervical spine. For artificial disc replacement and posterior cervical laminoplasty, it is best to remove the cervical brace early after surgery to help restore the mobility and muscle strength of the cervical spine.
V. Sixth week to three months after surgery.
Usually there is no need to wear a collar, and the neck can gradually resume activities according to the review. It is necessary to wear a collar when going out or riding in a car to protect the cervical spine in case of emergency. Generally, the healing time of anterior cervical implant takes 3-6 months. Before the implant is completely healed, strenuous exercise or special position may cause the implant and plate to be displaced.
VI. Special cases.
1.After the anterior cervical spine surgery, sometimes there will be a short period of hoarseness in pronunciation, choking and coughing, and sometimes there will be soreness, tingling or numbness in one or both upper limbs, shoulders and back, front chest, etc. This is mostly due to the stretching and stimulation of the soft tissues or nerve roots in front of the neck because of the surgery, which will return to normal after a period of treatment and recuperation.
2, cervical posterior spinal canal expansion surgery: sometimes 2-3 days after surgery (a week after surgery in individual cases) when one side of the deltoid muscle weakness, manifested as upper arm lifting arm difficulties, medically known as “cervical 5 nerve root paralysis”, this phenomenon is due to the original very narrow cervical spinal canal expansion, the spinal cord to obtain decompression at the same time also moved to the rear, in this process the nerve root will be subject to a certain stretch.
The normal edema reaction in the wound reaches its peak 2-3 days after surgery and sometimes manifests itself as a brief period of nerve root paralysis. In most cases, it returns to normal after 3-6 months and usually leaves no after-effects. Within 2 weeks after surgery – the neck can move freely, and movements such as lowering, tilting, turning the head from side to side and tilting the head are not restricted. However, you need to wear a collar to protect the cervical vertebrae when you go out and ride in a car, just in case.
3, posterior cervical spine surgery: 2-6 weeks after surgery – patients should avoid holding and carrying heavy objects with both hands to avoid affecting the tissue healing and rehabilitation of the back of the neck.
4.Posterior cervical spine canal enlargement + bone graft fusion: within 6 weeks after surgery – it is necessary to wear a collar to protect the cervical spine during normal times and when going out and riding in a car. From the seventh week to three months after surgery – the collar is not needed at ordinary times, and the neck can move freely, such as lowering the head, tilting the head, turning the head left and right, and tilting the head, etc. are not restricted. However, you need to wear a collar when you go out and travel in a car to protect your cervical spine in case of emergency.
VII. Note on discharge from hospital.
Discharge from the hospital must be fully communicated with the doctor.
First, discharge with medication, discharge records, diagnosis and leave certificates, etc., to avoid trouble later.
The second is to clarify the issues that you are worried about that are not clear to avoid confusion and anxiety that will affect your recovery when you go home.
The third is to clarify the precautions to be taken after discharge and the time and place to come to the hospital for review.