Neck surgery

What are the possible risks or complications of surgery?

These might include the following.

Deep infection

This happens in around  1 in every 100 cases. You’ll usually have antibiotics into a vein at the time of surgery to reduce this risk.

Superficial wound infections

4 in every 100 patients get this and may need a short course of antibiotics.

Bleeding

Less than 1 in every 100 patients have a major bleed which may need treatment.

Durotomy (damage to the dura)

The dura is the delicate sac that contains the spinal nerves inside the spinal canal. Occasionally, around 1 in 25 cases, this can get snagged or torn accidentally during the surgery.

We can usually repair the dura at the time and it won’t cause any long term problems. You might have a headache for a couple of days afterwards.

Blood clots

These may happen in the deep veins in your legs or lungs. We’ll give you surgical stockings and pumps on your legs during surgery to reduce this risk.

Sensory change or muscle weakness in arms

This is uncommon and may happen in around 1 in 100 cases due to nerve root damage. It’s usually temporary but sometimes can be long-term. Problems with nerve function in up to 31% of patients are mostly temporary.

Post-op bladder or bowel dysfunction

The risk of damage to the nerves that supply your bladder and bowel is very rare (1 in 1,000 cases).

Repeat surgery

1 in every 100 patients have more back surgery during the 10 years that follow neck surgery. This is because of ongoing wear and tear changes elsewhere in your spine.

Age

For elderly patients some risks increase slightly. These include:

• blood clots
• heart attacks
• urine/chest infection
• heart failure.

Return of pain

In less than 1 to 5 in 100 people, the natural process of healing by scar tissue causes pain to return by covering the nerves in too much scar tissue. Physiotherapists can treat this. In some cases you may need a referral to the pain team after surgery.

Temporary damage

This can happen in up to 1% of patients and include:

• blood vessel damage
• urinary tract infection
• urinary retention
• vertebral fracture.

Digestion problems

These can affect up to 7% of patients.

Problems with metal work used in surgery

This may involve breaking screws or rods, or the bone failing to heal around the metal leading to movement of the screws. This may or may not need further surgery in the future. Problems with the cage supporting the vertebrae, or the bone graft affect 5 out of 100 cases.

Complications from taking a bone graft from the pelvis

This might include graft site pain and damage to the sensory nerve supplying sensation to front of your thigh.

Pain from other areas in the neck

This can happen in the long term or in years to come,

Positioning during surgery

In rare cases this can cause:

• pressure problems
• skin and nerve injuries
• eye problems (very rarely blindness).

We use special operating tables to reduce these risks. Shoulder problems and upper limb nerve problems are also a risk.

Are there any serious complications?

Yes but these are very rare.

Damage to the spinal cord can result in paralysis or loss of bowel and bladder function. This can happen due to bleeding into the spinal canal after the surgery (a haematoma). We make every effort to reverse this by returning to surgery to wash out the haematoma, but can’t guarantee recovery of the nerve damage.

Stroke, heart attack or other medical or anaesthetic problems can also happen.

General anaesthetic fatal complications have been reported in 1 out of 250,000 cases. Death, although extremely rare has also been reported in 1 out of 250,000 cases under general anaesthetic.

Specific risks associated with anterior surgery (ACDF, ACD-R and corpectomy)

These risks relate to surgeries where the surgeon does the operation from the front of your neck.

Stroke

There’s a slight risk of injury to the vertebral artery (blood vessel) that runs along the side of the spine. This can happen when the surgeon removes the cervical vertebral body and could lead to stroke and/or life threatening bleeding.

Bleeding in the wound and swelling in the windpipe

This can cause difficulty in breathing or swallowing. It’s rare but if it happens you may need to go back to the operating theatre to stop the bleeding.

Bone graft/cage/artificial disc movement

This can happen in 2 out of 100 cases and you may need another. In very rare cases, movement can cause severe damage and paralysis.

Damage to the windpipe (trachea) or food pipe (oesophagus)

This happens in fewer than 1 in 100 cases.

Injury to the small nerve that supplies the vocal cords

This can cause:

• temporary hoarseness of the voice
• permanent, but rare hoarseness of the voice
• temporary strained and uncomfortable swallowing.

You may need to eat soft food for a few days.

Droopy eyelid

This can happen in 1 in 100 patients. It’s not usually obvious and nearly always improves.

What can I do to prepare for surgery?

It’s important to look after yourself by syating healthy, eating a well balanced diet and keeping your weight down.

If you smoke, you must stop or at least cut down. Get advice from the pre-operative assessment department through their ‘live well, stay well’ campaign.

You should also:

• ask questions about the procedure and know what you’re signing on the consent form
• make plans for your recovery at home following surgery.

This may include telling your employer, making sure you have a care package if you’ll help and having someone ready to take you home when we discharge you. Make sure you plan for meals, childcare and carers..

What will happen before my operation?

We’ll send you an appointment for a pre-operative assessment. This involves a general health check to make sure you’re fit for surgery. A nurse will do blood and urine tests, x-rays and any other tests we may need.

We’ll also ask you about any medications you’re taking including herbal medicines. Please bring your medicines, or a full list of your current medication with you to the pre-operative assessment appointment.

Plan for a half day at your appointment. You can bring a family member or someone else with you. There’s a hospital cafeteria on site for drinks and food.

You must tell us about any changes to your medication or health before your operation.

We’ll tell you before your operation when to stop eating and drinking.

What do I need to bring with me to hospital when I come for my operation?

You’ll need to stay in hospital so make sure you bring toiletries, night clothes, medication and any small electronic devices you may need.

See our list of recommended things to bring with you.

What will happen on the day of surgery?

Your anaesthetist will assess you before surgery. They may ask if you have a preference for a local or a general anaesthetic. The  anaesthetist will make the final decision about the type that’s best for you based on

• your preference
• the type of operation you’re having
• your general condition
• any previous experiences you’ve had with different anaesthetics.

When you arrive in the anaesthetic room, the operating theatre staff will check your notes and ask you more questions. Don’t be alarmed if several people ask you the same questions.

What happens after surgery?

We’ll take you to the recovery room where a nurse will monitor your progress. They’ll:

• check your breathing, pulse, temperature and blood pressure
• ask how you feel
• ask you to take deep breaths
• check the circulation and sensation in your legs and feet
• ask and assess if you have any pain.

What will happen while I’m in hospital?

From the recovery room, we’ll take you to the orthopaedic ward where we’ll look after you for the rest of your stay.

You may return from theatre with a urinary catheter if needed. We’ll remove this as soon as you can walk to the toilet.

Intravenous fluids and oxygen

You may have intravenous fluids or a patient controlled analgesia (PCA) which gives you pain relief through a drip until you’re comfortable. This isn’t done regularly. You may need oxygen through a mask or nasal tubing. Very uncommonly, you may also have a drain on your wound.

Collar

You may need a soft or hard collar after your operation. This will depend on what type of operation you had. Your surgeon will recommend which collar is best and how long to use it for.  Most of the time, it’s only for comfort and extra support. You should use it less as you get more comfortable and your pain feels more controlled.

On the ward the nurses will check your breathing, pulse, temperature and blood pressure. They’ll check the dressings applied to your incision and the drain if you needed it.

What can I expect after my operation?

If your pain is under control, you should be able to sit up in bed and walk to the toilet with assistance. A physiotherapist will show you exercises, explain how to increase your mobility and get back to normal.

The physiotherapist will also check you can walk safely and manage stairs if necessary. When they feel it’s safe for you to walk, you can go home. This can be the same day as your surgery or the following day.

If you stay in hospital over 24 hours, a pharmacist will visit the ward to check your medication is right for you. They can answer any questions about your medication.

Your arm pain might go immediately after the operation. Sometimes it may take up to 8 weeks or longer to go as the nerve needs time to recover from the pressure it had on it. You may still need to take pain killers or neuropathic medication. It’s important to slowly stop using them.

The wound may be a little sore and we’ll give you pain relief for this. The soreness will go in a few days.

If you had cervical myelopathy

This type of myelopathy involves compression of the spinal cord in the neck. If you had surgery for cervical myelopathy, any improvement in hand function or walking ability may be slight and can happen slowly over the next year or so.

If you had lot of numbness before surgery, some feeling may return but it probably won’t go away completely.

After the surgery you may still have some neck pain.

How will I control my post-surgery pain?

We help make your stay in hospital as comfortable and pain-free as possible. Our dedicated pain team who will visit you if needed.

You may have one or a combination of drugs and methods depending on the procedure you have had. You might have some pain relief during surgery and others after you wake up.

If you have any questions or concerns about the management of your pain, ask any member of the team. There’s evidence that reducing pain and anxiety helps recovery after surgery.

During your stay in hospital, we’ll ask you to measure your pain when you move. This helps the nurse give you the most suitable pain relief to control your pain.

We use a score to measure your pain on a scale of 0 to 10. 0 is no pain and 10 is severe pain.

Recovery from day of surgery to discharge

	Day of surgery	Pre-discharge to home	Discharge goals
Nutrition and elimination	Nil by mouth before the operation Intravenous until you can manage oral fluids Eat light supper Sit out on the commode	Eat and drink Walk to the toilet Bowels opened before discharge	Appetite returned Passing urine with no problem
Hygiene	Shower/bath before the operation Mouth care after the operation	Help with hygiene care Shower with help	Fresh and comfortable
Wound care	Observation of incision and drainage if needed	Check if dressing is dry and intact If yes, no change of dressing needed until your appointment for wound check	Healing noted
Pain control	Intravenous analgesia (uncommon) and oral NSAIDNonsteroidal anti-inflammatory drugs, for example,  ibuprofen	Oral pain relief	Pain controlled
Activity and rehabilitation	As soon as you and the nurses feel you can, you can walk to the toilet with assistance. Unless instructed otherwise	Sit in an upright chair, dining chair or a supported chair.Sit for meals.Gradually increase sitting time for short period over a week as comfort allowsFor the first few weeks, until 6/52 post discharge, you should not do any repeated bending or any lifting	Mobilise comfortably
Discharge planning	Anticipated date of discharge	Follow-up appointment organised and sentMedication TTO’s (to take out) writtenPractice nurse letter and TTO’s suppliedStocking instructionHelpful hints	Everything explained and understood

 

What exercises can I do after surgery?

After a single level ACDF or ACD-R operation you should start trying to move your neck as soon as you can. To begin with this may feel a little uncomfortable. The aim is to do small amounts of neck movement on a regular basis.

Our physiotherapists will see you while you’re in hospital and give you some simple exercises to do. The exercises will help you recover after your neck surgery.

Remember these exercises should be slow and gentle and done within a comfortable range. Never push exercise into a painful range.

You may feel some discomfort. This is normal but if your pain increases do the exercises more gently with fewer repetitions. If your pain continues, stop the exercises for a few days and gently build them back up.

Use the pictures below as a guide. We don’t expect you to necessarily reach the same range.

Ankle/quads (thighs)/glutes (buttocks)

Step 1

Bend your ankles up, then point your toes away from you. Repeat 20 times

Step 2

Circle your ankles clockwise and anticlockwise.

Step 3

Repeat 20 circles in each direction.

Step 4

Tense your upper thigh muscles. Hold for 5 seconds and repeat 5 to 10 times on each leg.

Step 5

Repeat tensing your glutes (buttocks) to hold for 5 seconds and repeat 5 to 10 times on each side.

Side bending movements

Gently tilt your head by bringing your ear towards your shoulder. Repeat on the other side.

Repeat 3 to 5 times each side.

Head turning movements

With your chin tucked in, gently turn your head to the side as far as comfortable. Repeat on the other side.

Repeat 3 to 5 times each side.

Neck bending

Bend your head down gently but not to the point of pain or stretch. Repeat 3 to 5 times.

Walking

The best exercise you can do is walking. Gradually increase the amount you do each day.

Make sure you change position regularly, around every 30 minutes, to avoid feeling stiff.

Everyone progresses at different rates post operatively. It’s important to do things slowly at first and build up the amount you do gradually. Good and bad days are normal.

What can I do to help myself recover well after surgery?

Take regular pain relief

Some pain is normal after surgery. This will lessen to a dull ache after 48 to 72 hours after the operation.

Pain control is important, particularly in the first few days and weeks. It’s best to take regular pain relief instead of letting pain build up. This will help you feel comfortable and able to get active.

Keep your wound clean and dry

Your wound like any cut may feel sore to begin with but you won’t do any damage by moving.

We’ll only change the dressing as needed. You may need to visit your GP/practice nurse for a wound check or to trim your stitches. We’ll tell you if you need to do this

Keep your wound clean and dry following surgery.  Most dressings are shower proof but ask your nurse before you go home.

Don’t spend long periods lying down

You can lie in whatever position you find comfortable. It’s normal to spend short periods of time on the bed after surgery, expecially for the for the first few days. Don’t spend long periods in the day lying down.

Roll on your side to get out of bed

You may find it easier initially to:

• roll onto your side
• bend your hips and knee
• swing your legs over the side
• push up with your hands.

You can progress to getting up normally over the next few weeks.

Sit in an upright chair

You may find you’re more comfortable in an upright supportive chair instead of low chairs or sofas for the first couple of weeks.

Try using a lumbar roll or cushion in the small of your back for comfort when sitting. Change position regularly, alternating between lying, sitting and walking to avoid feeling stiff.

Washing/bathing

Shower or strip wash for the first few weeks instead of using the bath until the wound fully heals and dried. Being comfortable getting in and out of the bath and sitting in the bath may take a few weeks.

Rest

Rest for short periods if you need to, but try to alternate rest with gentle exercise and gradually increasing to normal activity.

Go for short walks daily. Don’t spend all day lying down.

When can I restart your normal activities?

Timescales depend on your surgery. If you’ve had a fusion the timescales may take longer.

You may have had problems with balance and weakness affecting walking and arm function before your operation. It can be hard to predict expected improvement which may affect how quickly you can return to normal activities.

Lifting

Avoid heavier liftingfor the first 3 months after surgery. You can lift a lighter weight like a full kettle from about 3 weeks. You must keep your arms close to your body with your neck in a good position.

Bending forwards

Avoid excessive bending forward for the first couple of weeks. It’s easier to bend from your knees instead of your back. You may need some help initially putting on your shoes and socks.  Many people get slip-on shoes or put them on in a seated position by crossing their legs over.  A shoe horn may be useful.

Work

You must get fit to return to work which means gradually increasing what you do each day. You don’t need to be completely pain free to return to work.

You can return to work as soon as you feel comfortable to do so, as discussed with your surgeon.

If your work involves sitting at a desk, you can return to work after 3 to 4 weeks as long as you can keep moving.

If you have a heavy manual job you may need longer to recover (8 to 12 weeks). When returning to work, it’s likely you’ll need to gradually increase your working hours and days over a few weeks before returning full-time. This is called a phased return. Talk to your employer’s HR department or occupational health.

Driving

As a passenger, recline the passenger seat in the car slightly to make it easier to get in and out of the vehicle.

You can’t drive for at least 2 to 4 weeks. If you’ve had a fusion then may be longer.

When you’ve considered whether to drive, you must:

• have no altered sensation or weakness in your arms
• be able to move your head freely
• feel confident enough to do an emergency stop with full pressure on the brake pedal with no significant pain in your arm or neck.

Break up long journeys so you can change position and move around. Gradually increase the distance you travel, initially no longer than 20 minutes, over the next 4 to 8 weeks.

Check with your insurance company and with the Drivers Medical Group at the DVLA in Swansea. You may need to tell them that you’ve had an operation. You can get more advice at your outpatient appointment.

Sex

There’s no reason to avoid sex during the recovery period. You might prefer to be the passive partner or try different positions to find the most comfortable for you.

Activity, exercise and sport

It’s important to keep as mobile as soon as you can after surgery as this reduces your risk of getting a blood clot in your legs.

Get up and move regularly (every 20 minutes or so). Walking is the best activity to start after your surgery. Gradually build up the amount of walking you do each day.  Walking outside is okay but be careful not to trip over on uneven ground.

Get into a routine so you gradually walk a bit further. You may find it helpful to use an app on your mobile phone to count your daily steps. Remember to put the phone in your pocket.

Check with your surgeon and physiotherapist when you can return to sporting activities like swimming or golf. Advice ranges from between 6 weeks to 3 months.

For previously fit sports people, you can resume training at 12 weeks, or take part in non-contact sports. All activities will need a gradual increase in time spent on the activity, activity intensity, and frequency.

You mustn’t do an any impact sports such as jumping or running for the first 12 weeks.

When will I see the surgeon’s team for a review?

A doctor will see you at an outpatient clinic around 6 weeks after the operation to check your progress. Discuss any queries you may have when you’re at the clinic.

We may need to make further outpatient appointments if necessary. For single-level ACDF or ACDR, your surgeon will request an outpatient physiotherapy appointment to start 4 weeks after your surgery.

For other types of surgery, the surgeon will decide when physiotherapy should start.

What should I do if I have any problems?

Call 01494 426398 or 111 or go to A&E out of office hours if you:

• have a high temperature of 38C or above
• have increasing pain, numbness or weakness in your legs, back or buttocks
• can’t move your legs
• can’t pee or control your bladder
• have a severe headache
• get a sudden shortness of breath (this could be a sign of pulmonary embolism, pneumonia or other heart and lung problems).

Also, if:

• your stitches come out
• your dressing gets soaked with blood
• your wound leaks fluid or there’s redness.

Links and resources

Patient information about other back and spine conditions

Causes, treatment and help for neck pain

Exercises for neck pain

How can I help reduce healthcare associated infections?

Infection prevention and control is important to the wellbeing of our patients so we have procedures in place. Keeping your hands clean is an effective way of preventing the spread of infections.

You, and anyone visiting you, must use the hand sanitiser available at the entrance to every ward before coming in and after you leave. You may need to wash your hands at the sink using soap and water. Hand sanitisers are not suitable for dealing with patients who have symptoms of diarrhoea.

More help or advice

Contact our patient advice and liaison service (PALS) on 01296 316042 or bht.pals@nhs.net

We aim to make the information as up to date and accurate as possible, but please note that it’s subject to change. You must always check specific advice on any concerns you may have with your doctor.

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