I. Post-operative day 1 (24 hours).
1. Recuperation position.
Anterior cervical spine: bed rest with the head of the bed elevated 30 to 40°, which is conducive to reducing blood leakage from the incision. Change position appropriately every 2 hours to prevent pressure decubitus ulcers. You can lie on your back and side, and keep the pillow at the same height as your shoulder in the lateral position, and the cervical spine in a natural flat and neutral position. Tang Xianye, Department of Spine Surgery, Affiliated Hospital of Xuzhou Medical College
Posterior cervical spine: can be supine and lateral. 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 recumbent position is recommended to avoid problems with the posterior cervical wound as well as internal structures due to compression, which can affect the surgical results. 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, side lying position is preferred, and the height of neck and back pillows should be adjusted when lying on the back. Change the position every 2 hours to prevent the formation of pressure decubitus 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, avoid cervical extension and flexion, rotation, including head twisting, head nodding. Pay attention to keeping the neck neutral and upright when turning over, but avoid twisting the neck.
3. Diet.
You can eat water 4 to 6 hours after waking up from general anesthesia, with easily digestible liquid food and semi-liquid food as the main food.
4.Postoperative pain relief.
Cervical spine surgery incision pain is generally mild, simple symptomatic treatment is sufficient, most do not need analgesic pump.
5.Focused observation: vital signs, airway, drainage tube and nerve function of the extremities.
Cardiac monitoring: observe blood pressure, pulse rate, 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, oxygen, etc. Most of them are relieved in 2-3 days, and tracheotomy kits are prepared at the bedside, and tracheotomy may also be needed if necessary.
Drainage tube: If the surgery is fine and hemostasis is complete, no drainage tube can be placed. If a drainage tube is placed, it needs to be observed for patency and the amount of drainage flow; if the drainage bulb is almost completely inflated due to the accumulation of more old blood or gas, call the nurse for treatment in time to avoid excessive blood retention in the wound causing hematoma or causing infection. The drainage tube will need 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 widens, especially if the strength and range of motion of the lower extremities decreases, it is necessary to promptly notify the medical staff for treatment. Start functional exercises of the limbs, which can be used with massage and elastic stockings to prevent deep vein thrombosis of the lower limbs.
Second, postoperative day 2 to 3 (24 to 72 hours).
1. Body position and neck braking.
You can wear a neck brace to get up on your side and move away from bed. You can practice walking with a walker first, and then gradually walk normally, but you should avoid cervical extension and flexion and rotation, including twisting and nodding your head.
2. Diet.
Take easy-to-digest semi-liquid food as the main food, 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 drainage flow is less than 50 ml in 24 hours, consider whether to remove the drainage tube according to the needs of the condition.
4.Cardiac monitoring.
If blood pressure, pulse rate, heart rate, oxygen saturation and other important vital signs are stable, it can be removed the day after surgery.
5.Respiratory tract.
It can be continued with nebulized inhalation to reduce respiratory symptoms.
6.Neurological function.
Continue to observe the sensory-motor function of the extremities, especially 3 to 4 hours after the drainage tube is removed. 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 to 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 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 review.
Discharge from the hospital is usually scheduled at 4 to 7 days after surgery. Those with intracutaneous cosmetic sutures do not need to remove the stitches; for those with general silk sutures, the stitches will be 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 to 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 to 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 to 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 to 3 days after surgery (one week after surgery in individual cases), one side of the deltoid muscle weakness, manifested as upper arm lifting arm difficulties, medically known as “cervical 5 nerve root palsy”, 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 certain strain. The normal edema reaction in the wound reaches its peak 2 to 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 to 6 months and usually leaves no sequelae.
Within 2 weeks after surgery, the neck can move freely, and there is no restriction on movements such as lowering the head, tilting the head, turning the head from side to side, or tilting the head. However, you need to wear a collar to protect the cervical spine when you go out or take a ride in a car, just in case.
3.Posterior cervical spine surgery: within 2 to 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 posterior part 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 or riding in a car. From the seventh week to three months after surgery, you do not need to wear a collar, and your neck can move freely, such as lowering your head, tilting your head, turning your head left and right, and tilting your head. However, it is necessary to wear a collar when going out or riding in a car to protect the cervical spine in case of emergency.
VII. Note on discharge from hospital.
Discharge from the hospital must be fully communicated with the doctor, one is to discharge with medication, discharge records, diagnosis and leave certificate, etc., to avoid trouble later. Second, to clarify their concerns about unclear issues, to avoid confusion and anxiety affect their recovery after returning home. Third, clarify the precautions to be taken after discharge and the time and place to come to the hospital for review.