Post-operative recovery following cervical decompression surgery

Introduction

This leaflet provides you, your family and/or carers with advice and guidance about what to expect, how to care for yourself, and what to do if you have any concerns after you have left hospital following cervical decompression surgery.

Background

Cervical decompression is an operation to relieve the pressure on the nerves or spinal cord in your neck. The pressure is caused by natural ‘wear and tear’ changes in the discs, ligaments and joints. More information on this, and the specific approach of the operation which has been recommended for you, has been provided in the letters you have been sent by your surgeon and in the leaflet given to you before the operation.

The pressure on these nerves may have caused you to experience pain in your neck, arms or hands. Sometimes, when the pressure is on your spinal cord, it can also cause numbness or weakness in your arms and legs, difficulties walking and disturbance to your bladder and bowel function.

The purpose of the operation is to relieve this pressure and, primarily, prevent any progression of the neurological symptoms. Approximately 65% (65 in 100) of patients will experience improvement in their quality of life, but most improvements in symptoms may be only subtle, and take time to become apparent.

Expectations regarding recovery

General advice and guidance

Wound care

Keep the wound dry until completely healed. The wound will be covered with a small waterproof film dressing – please remove this carefully after 48 hours to check the wound and re-dress using the spare dressings given to you by your nurse. Please ask your nurse for one if you haven’t been given these.

You should have received a Wound Information Leaflet regarding caring for your surgical wound. Please ask your nurse if you haven’t been given one.

Your wound stitches are often absorbable, which means that they will not require removal. However, instructions for what to do if this is not the case will be included in your discharge letter (usually, you can make an appointment with your GP practice nurse to remove the stitches 10-14 days after your surgery)

In some people, a small amount of fluid collects under the skin where the surgery was performed and, as a result, a small bulge under the skin develops. This usually disappears in the weeks following surgery as this fluid is reabsorbed by your body.

Please note: If you notice that your wound is red, swollen or persistently oozing, please contact your specialist nurse, GP or call 111 for advice.

If a clear, watery fluid is leaking from the wound and you develop a headache or a temperature, please attend A&E (Accident and Emergency) urgently for assessment.

Pain Management

You are likely to experience neck pain following your surgery. This is particularly the case if your operation has been carried out in the back of your neck (posterior approach), and can sometimes also be experienced in the shoulders. This is often severe in the first week or two. When the operation is performed from the front of your neck, the pain is generally mild to moderate.

This pain may worsen initially, but you should experience a gradual improvement over the next six to eight weeks. You should then notice a significant improvement by 12 weeks after surgery. Regular simple pain relief (such as paracetamol and/or ibuprofen) usually helps, and this should be taken as per package instructions. It is important to remain active, in the form of walking, accepting that this might worsen the pain, as good levels of activity seem to be associated with faster recovery from postoperative pain.

Please note: If you experience severe pain in your neck (particularly if this is new), or if you find the pain is significantly worsening, please contact your specialist nurse, GP or call 111 for advice.

If you develop new weakness or numbness in your arms and legs, or NEW bowel/bladder dysfunction, attend A&E (Accident and Emergency) urgently for assessment.

Exercise

Whilst intensive physiotherapy is not recommended until your surgical wound has totally healed, our physiotherapy team recommends the following Exercise Programme:

Exercise programme following cervical spine decompression surgery

Should you experience any continuing neck pain three months after surgery, a physiotherapy review might be useful. Please contact your GP to arrange this.

We encourage you to increase your activity slowly after your surgery. This is particularly important for helping to manage post-operative pain.

• Where possible, walking is encouraged – increase your walking distance gradually until back to a normal level.
• It is important to keep your arms and legs moving to improve blood flow, and prevent them from becoming stiff or developing blood clots.
• Take regular rest, and let your body’s comfort be your guide to what is safe.

For the first few weeks, avoid:

• Heavy lifting (more than 5kg in each hand).
• Strenuous exercise or contact sports (for example: lawn mowing, running, digging and football).
• Carrying out activities which involve excess ‘pushing’ or ‘pulling’, or twisting / bending of the back

Swallowing difficulties

When a cervical decompression surgery has been carried out through the front of the neck (anterior approach), some patients experience some mild difficulties swallowing post-operatively. This can sometimes be accompanied by mild voice changes. In most cases, this resolves after a few days (though this may increase over the first two to three days) and, during this time, you may need to eat soft/pureed foods.

Please note: If you experience severe swallowing difficulties, or find you are coughing after eating and drinking, please contact your specialist nurse, GP or call 111 for advice.

If you notice that your swallowing difficulties or changes to your voice are progressively worsening after the initial few days, or are associated with any difficulties breathing, you must attend A&E (Accident and Emergency) for assessment.

Follow Up

Your surgical team will arrange a follow-up appointment for you after your operation. This is typically held three months after your surgery to allow sufficient time for you to recover, and allow for an accurate assessment of your symptoms.

The assessment will be conducted either face-to-face or over the telephone by one of the surgical team or your specialist nurse. Your surgeon will tell you if any X-Ray or other imaging is required before this appointment.

British Spine Registry

As a team, we are keen to seek feedback on the quality of your experience with us, and on how successful your surgery has been in improving your symptoms.

This data is collated and utilised to improve our service. Please visit this website and fill out a short questionnaire to record this feedback: British spine registry (opens in a new tab)

Frequently Asked Questions

Do I need to keep my ‘TED’ (Thrombo-Embolus Deterrent) stockings on after I go home?

Undergoing spinal surgery puts you at a higher risk of developing blood clots in your legs and/or your lungs (Deep Vein Thrombosis or Pulmonary Embolism). Being immobile (not moving) also increases this risk.

‘TED’ anti-embolic stockings help to reduce this risk. They should be worn until you are able to walk around comfortably, and are mobile for more than three to four hours daily.

Please note: If you experience swollen calves, or chest tightness and shortness of breath, attend A&E urgently for assessment.

When can I have a shower?

The dressing you have been provided with is splashproof. You are able to shower 48 hours after surgery, so long as you avoid your surgical area and pat dry the dressing. If the dressing gets wet, you can replace the dressing. You may shower as usual once the wound has completely healed. Please avoid taking baths or otherwise causing the operated area to be submerged under water, until the wound is fully healed (two to three weeks in most cases).

Can I drive?

You may resume driving IF you are able to make an emergency stop (and provided you were legally allowed and considered safe under DVLA Regulations to drive prior to your operation).

When can I return to work?

This will depend largely on you, your recovery and what sort of work you do.

It is usually safe to resume working at a desk as soon as you feel ready to do so, but please discuss with the clinician at your follow up appointment before resuming any manual work. We can provide an initial 'fitness to work' note, and further notes can be obtained from your GP if required.

I haven’t had any improvement in my symptoms. Is this normal?

Yes – many patients don’t notice any improvements in their symptoms after surgery. Often, if there are improvements, these are subtle and occur over time. Your surgical team will review your symptoms in your follow-up appointment, and give further advice at that point.

I’m experiencing constipation. What should I do?

Constipation following this type of surgery is not uncommon, due to the medications you receive whilst in surgery. Avoid opiate medications (for example morphine and codeine) if possible, and discuss with your pharmacist about recommended over-the-counter laxatives.

If your constipation persists despite this, seek advice from your GP or from NHS 111.

I’m experiencing ongoing Bladder, Bowel or Sexual Dysfunction. What should I do?

If you experienced altered bladder, bowel, or sexual function prior to your operation, and your doctor advised you that this was in relation to your spinal condition, this can take a long time to improve. Please contact your specialist nurse or GP if you require further advice on how to manage this.

If these symptoms are new, attend A&E (Accident and Emergency) urgently for assessment.

Contacts/further information

If you have any clinical concerns or questions, please contact the neurosurgical clinical nurse specialist of your consultant.

Aimee Bromwell/Marissa Asplen
(Mr Laing; Mr Francis; Mr Trivedi; Mr Kotter; Mr Crawford; Mr Hay)
01223 257163

Nicola Owen/Kirsty Grieve
(Mr Timofeev; Professor Hutchinson; Mr Kolias)
01223 216127

Giandomenico Basile/Ruth Mead
(Mr Mannion)
01223 256990

Peony Eschavez/Ruth Banaszkiewicz
(Mr Brown; Mr Guilfoyle; Mr Helmy)
01223 216189

If your surgery was completed by a consultant not mentioned on the list above, please contact any of the neurosurgical clinical nurse specialists, and they will be able to advise you.

Appointments

You should receive a letter through the post or via MyChart for a follow-up appointment. If this does not occur, or if you have queries in regards to this, please contact the neurosurgical secretaries (via switchboard 01223 805000)

My Chart

Cambridge University Hospitals which allows patients to securely access parts of their health record held within the hospitals’ electronic patient record system (Epic). It is available via your home computer or smart phone.

If you are interested in this please let us know and we can provide information, or look on our website: My Chart

References/sources of evidence

National Institute for Health and Care Excellence (NICE). Perioperative Care in Adults (Guideline: NG180]. Published: 19 August 2020.