After the Operation

What is the period of hospitalization?

Most people are able to go home after two to four days.

What can I expect in hospital after the operation?

You will probably be quite surprised by how quickly you will be able to get moving and at how easy neck movements are following the operation. We will usually aim to have you standing and taking a few steps later the same day or the day after the operation. You will have a small drain in place but this is easily removed after 24 hours. Physiotherapy is started early, working on movement and stabilization exercises; these are extremely important and will continue after you go home.

The nursing staff will work with you to try and ensure that any post-operative discomfort is kept to a minimum. Initially this may well be through the use of pain killing medication through a line which you control, according to your own needs, with the simple press of a button. (This is known as Patient Controlled Analgesia or PCA). However, very soon you will be able to switch to simple tablets.

Because the pharynx had to be moved to one side during your surgery, swallowing may well feel a little awkward initially and you may feel more confident with a soft diet for the first few days. However, this will quickly improve.

To minimize the risk of a deep vein thrombosis (DVT), which is the formation of a blood clot in one of the deep veins in the leg, you will be provided with special elasticized stockings. When you are resting in bed you will be fitted with A-V impulse boots and we will ask you (and remind you!) not to cross your legs, as well as advising special foot exercises. All these measures help to reduce the chance of a thrombosis forming, as will walking which is another reason we encourage you to get up and start mobilizing quite early.

The position of the disc replacement will be checked very carefully under X-ray control during the operation but a post-operative X-ray will be obtained just to make absolutely sure.

Once you are comfortable and happy with your ability to get up and move around, you are about ready to go home. This is usually by about the second or third day after your operation.

Will I need a collar?

We will give you a soft collar. This is not essential by any means but many people find the support helpful, at least at first.

What will my convalescence involve after leaving hospital?

The surgical wound
The skin incision will have been closed with clips and these will be removed, usually by your district nurse at home, after about five days. This is a very simple, painless procedure.

Activity and movement
You will need to continue with your programme of active home exercises and supervised physiotherapy after your discharge from hospital. This will usually involve attending a physiotherapy department about twice a week, either here at the Nuffield Hospital in the UK, or back at home. Our physiotherapy unit has developed a detailed protocol for treatment after cervical artificial disc replacement and our staff will always be happy to discuss this with you and your own local physiotherapist.

Initially your physiotherapist may use treatments to help settle any muscle spasm, but quite soon you will move on to more active treatments to build up the strength and stabilizing effect of the neck muscles and to restore neck movement. Working steadily on both strengthening and movement exercises will soon instil confidence and increase your flexibility. Movement will improve gradually and we intentionally do not push this too far during the initial period. We want to let the implant settle in and bond firmly to the bone, a biological process which takes a few weeks, although the immediate mechanical fixation is extremely strong. There is no risk of displacing the disc replacement with normal movement.
You will find that you are able to return to most normal day to day activities quite quickly. This should be a gradual and progressive process, guided by how you feel and by the progress you make with your physiotherapist. Take care and do not try and be too ambitious. It is important to achieve good muscle control before you start seriously pushing your range of movement; make sure you are happy with each stage in your programme before you try and move on to the next.

Driving and travel
You can return to driving as soon as you feel reasonably confident about your neck movements and with sitting comfortably for the necessary time. You need to be sure you can move your head and neck sufficiently to look for traffic. You should not drive if your concentration is impaired by feelings of discomfort or by taking medication which might make you drowsy.

There are no restrictions relating to air travel. We advise that you work on your neck exercises during the flight as sitting for a long period with little neck movement may cause some stiffness, at least in the first few weeks after surgery. Keep yourself well hydrated and consider taking half an aspirin a day, starting a few days before your trip, as these are measures which help reduce the risk of DVT.

Sports and fitness training
You will probably be able to return to light aerobic fitness training at your health club approximately four to six weeks after your surgery. You can discuss appropriate exercise with your physiotherapist. It is best to wait until about three months before returning to competitive sports.

Return to work
You will probably feel able to return to work after three or four weeks. However, it is better to avoid spending long periods of time sat at a computer or working at a desk and you should take regular breaks to work on your neck exercises. In the weeks after an operation you will tend to tire more easily so some people may prefer to return to work on a part time basis initially.

What can I expect in terms of symptoms after the surgery?

Although the recuperation after cervical artificial disc replacement is relatively quick, you are certainly likely to be aware of some discomfort and soreness in your neck. The wound itself will also feel quite tender initially but this settles quickly.

Other parts of your neck, such as the facet joints, will need to get used to the slight readjustment of the vertebrae and often the improved range of movement compared to what they have been used to! This again can cause some discomfort, particularly as you move your head and neck towards their maximum range. These symptoms will usually settle, but if they remain troublesome we will occasionally suggest some facet joint injections.
The surgery may result in a little irritation of the nearby nerve roots, potentially causing some discomfort radiating into the arm on one side or the other. Almost invariably, these symptoms will pass after a few weeks. If you are worried or if the symptoms are very troublesome, contact your GP or Mr Boeree's office.

Medical follow-up

When you leave hospital we will contact your doctor to ensure he or she is fully aware of your care needs following the operation. If you have clips which need removing we will arrange for this to be done at the hospital or by your district nurse.
You will be sent a follow-up appointment date scheduled for six weeks after your operation. In the meantime, your physiotherapist will keep Mr Boeree informed about your progress. You will have a further appointment with Mr Boeree three months after your operation, at which point X-rays will be obtained to check on the artificial disc and how it is functioning. If you have any concerns during this period, please feel free to contact Mr Boeree's office, although it is often worth discussing them first with your physiotherapist or GP.

 

 

 

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