I. Post-operative day 1.
1. Body position.
After anterior cervical spine surgery: bed rest with the head of the bed elevated by 30º, which is conducive to the drainage of blood exuding from the incision. Properly change the position every 2 hours to prevent the formation of pressure sores, supine or lateral, and keep the pillow at the same height as the shoulder when lying in the lateral position.
After posterior cervical spine surgery: you can lie in supine and lateral position, with lateral position being preferred to avoid problems with pressure on the posterior cervical wound and internal structures of the cervical spine, which may affect the surgical effect; it can also avoid accidents due to poor drainage caused by pressure on the incisional drainage tube and accumulation of stagnant blood. Special attention should be paid to not compressing the posterior part of the neck in the supine position, without padding pillows or towels, etc. A pillow that is too high or too low may distort the neck and cause intense discomfort or even pain, so the pillow should be kept at the same height as the shoulder when lying in the lateral position. If the back of the thoracic back is convex, the lateral position is better, and the height of the pillow for the back of the neck should be adjusted. Change the position every 2 hours to prevent the formation of pressure sores.
2.Focused observation: vital signs, airway, drainage tube and sensory-motor function of the limbs.
(1) Cardiac monitoring – observe blood pressure, heart rate, respiration, blood oxygen saturation and other important vital signs.
(2) Airway – Prepare tracheotomy kit at the bedside. Observe for cyanosis, sore throat, chest tightness, breath-holding, dyspnea, etc. The milder ones can be treated with oxygen, nebulized inhalation, etc. Tracheotomy is needed in case of respiratory distress, especially laryngospasm.
(3) Drainage tube – observe whether the drainage is smooth, the nature and amount of drainage fluid; record the drainage flow and replace the drainage device or drainage bag in time to avoid the formation of hematoma compressing the trachea due to poor drainage of stagnant blood, causing laryngospasm or secondary infection. If necessary, the drainage tube needs to be readjusted.
(4) Nerve function – observe the sensory-motor function of the extremities, ask and observe the sensory-motor condition of the upper and lower extremities of the hands and feet once every hour, if the numbness worsens and the range expands, especially the power and amplitude of the lower extremity movement decreases, the medical staff should be informed promptly. Start the passive function calcination of the limbs, you can massage and use elastic stockings to prevent the formation of deep vein thrombosis in the lower limbs.
3.Neck braking.
Wear a neck brace to limit neck activities, avoid cervical rotation, flexion and extension, i.e. head twisting, head nodding movements. Turning should avoid neck twisting, pay attention to keep the head and face with the neck and trunk turning at the same time.
4. Diet.
4-6 hours after awakening from general anesthesia, a small amount of water and fluid juice, semi-fluid diet can be consumed, and no solid food for the time being.
5.Postoperative pain relief.
Postoperative cervical spine incision pain can generally be tolerated, non-opioid analgesics can be given if necessary, and most analgesic pumps are not needed after surgery.
Second, postoperative days 2-3.
1. Drainage tube.
The purpose of drainage is to draw out the accumulated blood in the wound. Generally, the flow of drainage is less than 50 ml in 24 hours, and the doctor will consider removing the drainage tube according to the condition.
2. Cardiac monitoring.
If the blood pressure, heart rate, respiration, blood oxygen saturation and other vital signs are stable, it can be removed the day after surgery.
3.Position and neck brake.
You can wear a neck brace to get up on your side, leave the bed and move around indoors, and it is appropriate to remove the drainage tube before getting out of bed. It is best to use the walker to practice walking first, and then gradually walk normally, but should avoid neck rotation and head nodding movements.
4. Diet.
Easy-to-digest semi-liquid food is 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.
5. Respiratory tract.
You can continue with nebulized inhalation to reduce respiratory symptoms.
6.Neural function.
Continue to observe the sensory-motor function of the extremities, especially 3-4 hours after removal of the drainage tube. Pay attention to observe whether there is any change in the sensory-motor function of the limbs and symptoms such as dizziness and headache compared with those before surgery, and whether symptoms such as panic, chest tightness, nausea and vomiting appear, and inform the doctor in time.
7. Review the cervical frontal and lateral X-ray film to understand the sequence of cervical spine, bone graft and plate and screw position.
III. Postoperative days 4-7.
Wear a neck brace to get up, get up on your side, and perform functional exercises of the limbs appropriately.
Postoperative cervical spine CT and MRI examination can be done to judge the effect of surgery and facilitate later rehabilitation.
Discharge from the hospital can generally be considered at 4-7 days after surgery. For those with intradermal cosmetic sutures, no suture removal is required; for those with general silk sutures, sutures are removed one week after anterior cervical approach and 12-14 days after posterior cervical approach, which can be removed at outpatient clinics or community medical institutions near home.