The good news for those patients who have tried conservative treatments for their neck pain and are now facing surgery, is that in general people do extremely well with anterior cervical surgery and the success rates are very high, above 90-percent, for long-term pain relief. Because every surgeon manages their post-operative patients a little bit differently, and because every patient's case is different it is difficult to say exactly how you or your loved one will feel following surgery. The main differentiating factors are whether or not the patient opts to have a plate implanted or wear a cervical collar in order to stabilize the fusion, and whether the patient decides to have bone grafted from their hip (autograft) or donor bone (allograft) used to replace their disc. But in general most patients recover quickly and find relief almost immediately with a single-level fusion.
For those patients, the usual hospital stay consists of spending the night and going home the next day. However, the length of the hospital stay also depends on doctor preference and hospital policy. Some hospitals require a patient stay overnight, others are a little more liberal. But again this will depend on the physician and on the hospital where the patient has their surgery. In general, anterior cervical surgery is very well tolerated and has minimum discomfort. Fairly routinely patients will have some swallowing discomfort and may want to go with a softer diet like soups and milkshakes for a while. But after a couple days usually the throat soreness is gone and the neck pain is minimal. After about three days the incision is usually sealed and patients can shower. In general, the sutures are placed under the skin and absorb on their own. The incision will have a little redness in it for about three months and then will blend in with the skin crease. The incision is typically made in the skin crease, so cosmetically it is not disfiguring.
A patient may be prescribed a narcotic to use during the first two weeks after surgery, however physical therapy is often not a part of recovery unless the patient has had a significant neurological deficit (profound weakness). If a patient has had a deficit and that deficit has some improvement after surgery but plateaus at a certain point during the recovery then physical therapy is usually prescribed on a one-month basis three times per week with a reevaluation after that point.
The vast majority of patients will choose to have a plate implanted to stabilize their fusion. When this is the case, after surgery the patient usually can walk as much as they want, and go up and down stairs. As a precaution they are usually restricted from lifting over eight pounds which is about the weight of a gallon of milk. Patients should take it easy for about four to six weeks, though they can typically start driving after two weeks. After the four to six week rest period most patients with an implanted plate go back to work. During the two-week post-operative period is usually when the patient will see their physician for a check-up and this waiting period for driving ensures they have had ample time to recover from any soreness and diminished reaction time. Patients, with a plate, can usually go back to playing recreational non-contact sports, like golf or tennis, after four to six weeks. Playing contact sports is usually decided on an individualized basis. Often, patients must wait a year before they do any significant contact sports.
Some patients do not want any hardware or foreign bodies in their system, for these patients a hard cervical collar is used for three months in order to stabilize the neck and allow the fusion to heal. This decision significantly changes the recovery time for the patient. During the three months the patient wears the cervical collar, they can not drive and most of the time they can not work during this period.
In general the fusion rates for a single-level are very high using either donor (allograft) bone or autograft bone (bone from the patient's hip). Autograft bone is usually recommended for patients who smoke or have a prior history of pseudoarthrosis (non-union). Autograft will stack the deck in favor of fusion in these patients. But the complication rates from autogenous bone grafting carries with it some risk particularly with graft site pain. Allograft bone is usually the choice for those patients who do not fit into the smoking or prone to non-union categories. In general the literature supports that people fuse faster with autograft then with allograft but overtime the allograft bone is still in the 90+ percent range for one-level fusion. With autograft the fusion is well underway by four to six weeks, and probably solid by eight weeks while with allograft it tends to take around twelve weeks.
Recovery is also affected by how long the patient has had their symptoms for. However, most people that have cervical surgery will notice a difference in their symptoms in the first couple days after surgery. Some people have dramatic recovery. One of my patients had profound deltoid weakness. We tried physical therapy for about a month but that failed. Though he was not getting any better, his pain was very minimal. He continued to ask me "why do you think I need this surgery." My feeling was, the deltoids are a very important muscle group, and his inability to raise his arm above his head was a major quality of life issue. So we decided to go forward with the surgery, and two weeks later he had almost normal strength in his left deltoid and is pleased with his results. In general people will notice a difference after the first couple of days.
The main point for patients is you should always try to avoid surgery if you can. They are some very good conservative treatments including physical therapy, cervical traction, and medications that can improve your symptoms. But if all else fails talk with your doctor and choose the surgery that will best improve your quality of life.
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