If the individual has smoked in the past, it is vital that smoking not be resumed following surgery. Smoking, or any type of nicotine intake (including second-hand smoke), increases the risk of complications and interferes with the bone-healing process required for a successful fusion.

Activity can gradually be increased during recovery, and physical therapy is often helpful in this effort. Two to three months in physical therapy is common. In addition to offering guidance on safe ways to perform everyday tasks at home, physical therapists also can suggest ways to protect the neck before returning to work.

While uncommon, as with all surgery there are a number of risks and potential complications that can occur as a result of a cervical decompression and fusion surgery, including:

1. ·       Hemorrhage or formation of a wound hematoma
2. ·       Damage to the carotid or vertebral artery resulting in a stroke or excessive bleeding, even death
3. ·       Damage to the recurrent laryngeal nerve resulting in hoarseness
4. ·       Damage to the superior laryngeal nerve resulting in swallowing disturbance
5. ·       Damage to the esophagus or trachea resulting in infection
6. ·       Damage to the dura, resulting in a cerebrospinal fluid leak or pocket of cerebral spinal fluid beneath the incision (pseudomeningocele)
7. ·       Mechanical complications of the graft and plate (including graft migration, breakage of the plate, screw pullout, etc.)
8. ·       Wound infection
9. ·       Development of painful pseudoarthrosis (failure of adequate fusion to occur)
10. ·       Damage to the spinal cord or nerve root(s) resulting in pain, weakness, paralysis, loss of sensation, loss of bowel or bladder function, impaired sexual function, etc.

Initially, recovery after an ACDF emphasizes pain control—usually with narcotic pain medications—and walking. The patient will typically start walking the day of the surgery in order to promote healing and prevent potential complications.

After about a week using narcotic pain relievers, the patient may shift gradually to non-narcotic pain medication, usually acetaminophen, or Tylenol. Certain pain medications should be avoided for the first several months after surgery. This includes the common nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen, and COX-2 inhibitors.

In the first week at home, certain activities are restricted. For example, the patient needs to avoid turning the head sharply to the side, lifting anything heavy, and bending over. Driving must be avoided while the individual is taking narcotic pain medication or muscle relaxers. Patients are advised to move carefully, but a daily walking program is usually recommended.

While it is not the rule, sometimes the patient may be fitted with a neck brace to avoid unsafe movement and enhance stability. If this is the case, the patient will be shown how to put the brace on and take it off, and will be given instructions on how much and when to wear it.

• Don’t lift any objects over 5 pounds.
• Don’t smoke or drink alcohol.
• Don’t look up or down using your neck.
• Don’t sit for long periods of time.
• Have someone help you with any activities that may strain your neck.
• Wear a neck brace according to your doctor’s instructions.
• Attend regular physical therapy sessions.

Don’t do the following until your doctor tells you it’s okay:

• Have sex.
• Drive a vehicle.
• Swim or take baths.
• Do strenuous exercise, such as jogging or lifting weights.

Once your graft starts to heal, walk short distances, starting at about 1 mile and regularly increasing the distance, every day. This light exercise can aid in your healing process.

A few hours after surgery, the individual will be helped out of bed to take a short walk. After that, the patient will usually be directed to walk every 2 or 3 hours (during waking hours). Getting the blood moving from walking helps prevent pneumonia, blood clots, and constipation, and aids the healing process.


As a practical point, patients may find it best to come prepared to get up and walk shortly after surgery by bringing items such as safe slip-on shoes (many people like crocs), and shorts or a robe for modesty when walking the halls. Also, it is easier to get dressed before going home with a shirt that buttons up the front (rather than one that goes on over the head), easy pants, such as sweat pants, and slip-on shoes


Hospital or surgery center staff members will make sure the patient is stable before being sent home. The patient should make sure that he or she is fully informed of at-home care and safe recovery. The rest of this article provides information on the typical stages of recovery at home.

After surgery, you’ll wake up in the postoperative care unit and then be moved to a room where your heart rate, blood pressure, and breathing will be monitored. Hospital staff will help you sit up, move, and walk around until you feel comfortable.

Initially, the patient may experience one or any or a combination of the following:

Pain in the area of the surgery. Neck and arm pain as well as tingling and numbness may be encountered.
Pain where the bone graft was taken. If the patient's own bone was used, the area of the hip where the bone graft was taken may be painful.
Difficulty swallowing and sore throat. Having a sore throat and difficulty swallowing are common after surgery. The medical term for this is dysphagia. While the problem of a sore throat usually goes away within a week, the swallowing problem, or dysphagia, may linger.

Patients are placed on a clear liquid diet at first, with the hospital staff checking for swallowing problems. Solid food is added if swallowing is not an issue. Throat lozenges and cool liquids ease the pain in cases where swallowing problems persist.

Patients are typically given narcotic pain medications intravenously after surgery to alleviate their initial postoperative pain and discomfort. The patient may be provided with a pump to self-administer (within limits) the amount and timing of pain medication. Muscle relaxers may also be prescribed for patient comfort. The IV line will usually be taken out when the patient shows the ability to eat, drink, and take medications in pill or capsule form.

Once you’re able to move normally, your doctor will assess your condition and release you from the hospital with prescriptions for pain and bowel management, as pain medications can cause constipation.

If you have trouble breathing or your blood pressure hasn’t returned to normal, your doctor might recommend that you stay in the hospital overnight.

See your surgeon about two weeks after your surgery for a follow-up appointment. You should be able to do daily activities again in four to six weeks.

See your doctor right away if you notice any of the following:

• High fever at or above 101°F (38°C)
• Bleeding or discharge from the surgery site
• Abnormal swelling or redness
• Pain that doesn’t go away with medication
• Weakness that wasn’t present before the surgery
• Trouble swallowing
• Intense pain or stiffness in your neck

You will awaken in the postoperative recovery area. Blood pressure, heart rate, and respiration will be monitored. Any pain will be addressed. Once awake, you can increase your activity level (sitting in a chair, walking). Patients who have had bone graft taken from their hip may feel more discomfort in their hip than neck incision. Most patients having a 1 or 2 level ACDF are sent home the same day. However, if you have difficulty breathing or unstable blood pressure, you may need to stay overnight. 

Follow the surgeon's home care instructions for 2 weeks after surgery or until your follow-up appointment. In general, you can expect:

Restrictions

• Avoid bending or twisting your neck.
• Don't lift anything heavier than 5 pounds.
• No strenuous activity including yard work, housework, and sex.
• DON'T SMOKE or use nicotine products: vape, dip, chew. It prevents new bone growth and may cause your fusion to fail.
• Don't drive until after your follow-up visit.
• Don't drink alcohol. It thins the blood and increases the risk of bleeding. Also, don’t mix alcohol with pain medicines.

Incision Care

• If Dermabond skin glue covers your incision, you may shower the day after surgery. Gently wash the area with soap and water every day. Don’t rub or pick at the glue. Pat dry.
• If you have staples, steri-strips or stitches, you may shower 2 days after surgery. Gently wash the area with soap and water every day. Pat dry.
• If there is drainage, cover the incision with a dry gauze dressing. If drainage soaks through two or more dressings in a day, call the office.
• Don’t soak the incision in a bath or pool.
• Don’t apply lotion/ointment on the incision.
• Dress in clean clothes after each shower. Sleep with clean bed linens. No pets in the bed until your incision heals.
• Some clear, pinkish drainage from the incision is normal. Watch for spreading redness, colored drainage, and separation.
• Staples, steri-strips, and stitches are removed at your follow-up appointment.

Medications

• Take pain medicines as directed. Reduce the amount and frequency as your pain subsides. If you don’t need the pain medicine, don’t take it.
• Narcotics can cause constipation. Drink lots of water and eat high-fiber foods. Stool softeners and laxatives can help move the bowels. Colace, Senokot, Dulcolax and Miralax are over-the-counter options.
• If painful constipation does not get better, call the doctor to discuss other medicine.
• Don’t take anti-inflammatory pain relievers (Advil, Aleve) without surgeon’s approval. They prevent new bone growth and may cause your fusion to fail.
• You may take acetaminophen (Tylenol).

Activity

• If you were given a brace, wear it at all times except when sleeping, showering, or icing.
• Ice your incision 3-4 times per day for 15-20 minutes to reduce pain and swelling.
• Get up and walk 5-10 minutes every 3-4 hours. Gradually increase walking, as you are able.

When to Call Your Doctor

• Fever over 101.5° (unrelieved by Tylenol).
• Unrelieved nausea or vomiting.
• Severe unrelieved pain.
• Signs of incision infection.
• Rash or itching at the incision (allergy to Dermabond skin glue).
• Swelling and tenderness in the calf of one leg.
• New onset of tingling, numbness, or weakness in the arms or legs.
• Dizziness, confusion, nausea or excessive sleepiness.

ACDF surgery is mainly used to:

Remove a disk in your spine that has become worn down or injured.

Remove bone spurs on your vertebrae that pinch your nerves. Pinched nerves can make your legs or arms feel numb or weak. So treating the source of the compressed nerve in your spine with ACDF surgery can relieve or even end this numbness or weakness.

Treat a herniated disk, sometimes called a slipped disk. This happens when soft material in the center of a disk is pushed out through the firmer material on the outer edges of a disk.

You may be a candidate for discectomy if you have:

• diagnostic tests (MRI, CT, myelogram) show that you have a herniated or degenerative disc
• significant weakness in your hand or arm
• arm pain worse than neck pain
• symptoms that have not improved with physical therapy or medication

ACDF may be helpful in treating the following conditions:

• Bulging and herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation and swelling occurs when this material squeezes out and painfully presses on a nerve.
• Degenerative disc disease: As discs naturally wear out, bone spurs form and the facet joints inflame. The discs dry out and shrink, losing their flexibility and cushioning properties. The disc spaces get smaller. These changes lead to canal stenosis or disc herniation (Fig. 1).