Read EXPLANATION OF CERVICAL SPINE SURGERY text version

ANTERIOR CERVICAL DISCECTOMY AND FUSION

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Table of Contents

Frequently asked questions Page 3

The cervical spine and the different disease processes of the cervical spine

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Cervical spine surgery

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Bone Morphogenetic Protein

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What you should know before your surgery

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What to expect on the day of surgery and after your surgery

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Incision care and general self care tips

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Why you should not smoke

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The importance of aerobic exercise

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Important information about anterior cervical surgery, disability

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forms, obtaining medical records, antibiotics for dental work and billing information.

What to expect 6 weeks after surgery

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Frequently Asked Questions: 1. How long will the swelling last in my neck?

Every patient is different. The swelling can last for weeks, even a few months. The swelling should only slightly improve each week, but it is important that you call if it is not slowly improving.

2. How long should I avoid driving?

You should not drive while taking narcotics. You should avoid driving during the busy traffic times and remember to carefully position your mirrors before starting to drive. Some states do not allow collars when driving. You should wear your collar when driving, so if your states does not allow you to drive with a collar, then do not drive for the first 6 weeks post-op.

3. Why do I have pain in between my shoulders/muscle spasms?

When the disc degenerates, it collapses. When the bone graft is placed during surgery, it stretches the disc height back to its normal place, which is a change that your body senses. Once the bone heals, the pain should dissipate.

4. When can I resume sexual relations?

Sexual relations can be resumed 6 weeks after surgery when the patient feels he/she is comfortable to do so. The safest position for the patient is laying flat in bed.

5. When should I be concerned about my swallowing?

Swallowing problems and increased phlegm production after surgery are not unusual, but swallowing and breathing are not options. If swallowing becomes more and more difficult, then please call the office immediately. You may use Chloroseptic spray to help with the sore throat or Mucinex for increased phlegm production.

6. When can I lift weights?

Please avoid all overhead lifting for at least the first 6 months post-op. Lift light weights close to your body. No lifting over 10 pounds. Please keep the neck in a neutral position. No bending, extending or twisting the neck until Dr. Kim confirms that you are all healed, which can take anywhere from 6-24 months.

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The Cervical Spine:

You are being scheduled for surgery on your cervical spine. Dr. Kim has determined the type of procedure that is necessary for you after reviewing your symptoms, your physical assessment, your x-rays and the other studies that you have had. The bones in the cervical spine are called vertebrae. There are 7 vertebrae in the cervical spine. Each vertebrae in the cervical spine are cushioned by an elastic type shock absorber known as the disc, except the first two vertebrae which do not have discs. Each disc fits above and below the vertebrae from the cervical vertebrae #3 on down. The discs have a soft center, known as the nucleus, which is surrounded by a tough outer ring, known as the annulus. The discs allow the motion between the vertebrae. The discs, bony structures, ligaments and strong muscles all work together to stabilize the spine. The spinal cord, which is the nerve center of the body, connects the brain to the rest of the body. The spinal cord and nerves travel from the cervical spine through to the sacrum, the lowest point of your spine.

The Different Disease Processes of the Cervical Spine:

Compression or squeezing on the nerves in the spinal cord or nerve roots may be causing many of the different types of symptoms that you may be experiencing. These symptoms may include headaches in the back of the head, pain in the neck, shoulder, upper back, arm, and/or fingers. Numbness, tingling and weakness are other symptoms that you may be experiencing occasionally or regularly. Other more serious symptoms include loss of balance and problems with coordination and dexterity. The compression of the nerves are caused by some of the following conditions: 1. Degenerative Disc Disease: Degenerative disc disease is a process referring to the disc aging and loosing its ability to work as a cushion. During the aging process, or degeneration, the disc looses it elasticity, which can cause the disc to crack, flatten or eventually turn into bone. As the disc flattens, the bone (vertebrae) rub together which can then cause bone spurs. These bone spurs can cause pressure on the nerves.

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2. Herniated disc: The disc is the cushion between the vertebrae. The inside of the disc, known as the nucleus, is made up of mostly water. A disc herniation refers to the outer part of the disc, known as the annulus, tearing, thus allowing the soft watery material on the inside of the disc to come out of the disc. The disc herniation can then cause pressure on the spinal nerves and/or the spinal cord. 3. Bulging disc: A disc bulging refers to soft inner part of the disc remaining in the annulus, but that it is no longer in it proper place. The bulging disc can cause pressure on the nerves and/or the spinal cord. 4. Spinal Stenosis: Spinal Stenosis is where bone spurs narrow in the space through which the nerve roots and spinal cord exists in the spinal canal. 5. Spondylosis: Spondylosis is the degenerative arthritis of the spine. The arthritis can cause pressure on the nerve roots. 6. Radiculopathy: A disease process referring to the pressure on the nerve root causing you to have pain going into the arm(s). 7. Myelopathy: A disease process referring to pressure or compression on the spinal cord causing difficulty with walking, balance, and use of your hands. 8. Pseudoarthrosis: A disease process referring to the failure of the bone to fuse.

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Cervical Spine Surgery:

The cervical surgery that has been scheduled for you is to correct the problems that you have been experiencing in your cervical spine. Dr. Kim has discussed with you the possible surgeries that may assist in helping correct your problems. She has elected to perform an Anterior Cervical Discectomy and Fusion. This involves removing the disc and replacing the disc with bone to allow the vertebrae to fuse together as one. You may have a titanium plate and screws placed to hold the bone in place as it fuses. Dr. Kim usually uses donated bone that has been screened for diseases by the bone bank as bone graft. If you wish not to have donated bone please let us know your preference. We may be able to use bone from your pelvis. Cervical Spine One Level Anterior Cervical Discectomy

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INCISION: The incision will be made in a horizontal fashion in the front of your neck. If you have had surgery in the past on your cervical spine with a front approach, you may need to meet with an ENT (a doctor who cares for the ear, nose and throat) to evaluate the laryngeal nerves and the vocal cords. This evaluation allows Dr. Kim to be informed as to how your vocal cords are functioning, thus allowing Dr. Kim to determine which side of your neck to place the incision. The length of the incision depends on how many levels of the cervical spine that needs to be corrected. Anterior incisions usually will gradually fade over the next year, so that the incision is hardly noticeable. BRACE: A neck brace or collar will be worn after surgery. The brace should be worn as directed by Dr. Kim but usually if a fusion is involved the brace is used for 6 to 12 weeks after surgery. The brace is used to limit the motion of your neck so that the bone graft can incorporate and fuse. It is important to wear your collar as directed by Dr. Kim after the surgery. DO NOT flex, (bring your head to your chest) or extend (lift your chin up high and away from your chest). You must sleep with your collar on. You can remove your brace to shower or shave. You must ALWAYS wear your collar when driving or riding in a motor vehicle. If you have problems with the collar, please call the office. BLOOD LOSS: It is an unusual occurrence for you to need blood during any of the procedures that have been discussed. Dr. Kim will address this with you if you will need to donate blood for your surgery. If this has not been addressed, then Dr. Kim does not feel that donating your blood is needed for this surgery. There is a consent that you will need to sign that allows you to receive blood in a life threatening emergency. Otherwise, blood loss is usually about ½ -1 cup during these types of surgical procedures and is well tolerated by someone who is normally healthy. SPINAL CORD MONITORING: Spinal cord monitoring is a procedure performed by a nurse during the surgery. Electrodes are placed on the scalp and other parts of the body to make sure that the spinal nerves have good blood flow. You may or may not notice some irritation to

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your scalp after the surgery. This irritation should resolve within a few days after the surgery. RISK AND COMPLICATIONS: The list below includes some of the common possible side effects for this surgery. Fortunately, complications are very rare in Dr. Kim's practice. Please note that the list below includes some, not all of the possible side effects. · Side effects from anesthesia · Infection · Damage to nearby structures (Esophagus, Trachea, Thyroid gland, Vocal cords and Arteries) · Spinal cord or nerve damage resulting in paralysis · Bleeding or possible need for transfusion · Persistent hoarseness and/or swallowing problems. This may last for several weeks. Please call the clinic if this persists. · Injury to the vertebral artery resulting in a stroke · Bone graft shifting or displacement · Failure of the metal plates and screws that may necessitate another operation · The bone graft not healing properly, necessitating another operation · A blood clot can form in your arms or legs · Heart problems and even death · Injury to cerviothoracic nerve causing the eye to droop and eye dryness

BMP (Bone Morphogenetic Protein):

Dr. Kim may be using a drug called BMP as part of your operation to help your fusion (bone healing). Although BMP has been approved for use in the lumbar spine, it has not been approved for use in the cervical spine. There has been a small study conducted in the cervical spine that has shown it to be both safe and effective in helping the bone to heal. BMP has markedly improved the healing rate and has decreased the healing time for these patients. Dr. Kim's experience is that the BMP allows the bone to heal better than the patient's own bone. In fact, there are cases where we can decrease the amount of surgery and achieve the same

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outcome as a direct result of using this drug. Bone Morphogenetic Protein is like using superglue instead of the old-fashioned glue. PLEASE NOTE: It is very common 4-7 days after your surgery for you have an increase in swelling in and around the area of the surgery with the use of Bone Morphogenetic Protein. This will usually subside gradually over the next week to two weeks. Are there potentially some risks to using this drug? Whenever you use any drug, there are potential risks, including death. Patients can have allergic reactions, or the drug may work too well and form too much bone. Although we have seen neither of these complications, that does not mean that it cannot happen in the future. For this reason, Dr. Kim will continue to follow you and monitor your care at the post-operative visits at 6 weeks, 3 months, 6 months, and at 1 year. If you feel uncomfortable with the use of this drug for any reason, let us know and it will not be used for your surgery.

Before Your Surgery:

There are a few things that need to be done before your surgery. · Before your surgery it is necessary to have blood work, possible EKG if required and a chest x-ray. A chest x-ray is only done if you have a lung condition or a history of cigarette smoking. All of these tests have been scheduled for you and will be done during pre-admission testing when you meet with the anesthesia staff prior to your surgery date. You should bring your medication list to the appointment. If it has been some time since you have seen your primary physician and you have a lot of medical problems, it would be best that you see your medical doctor before your pre-admission test date. Another option is to be evaluated by medical doctors at Baylor who may be involved with your care during your hospitalization after the surgery.

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Before having surgery on your neck, you may be required to provide written medical clearance from your primary MD, Cardiologist, Hematologist, or Pulmonologist. Some patients will also receive a Pain Management consult for medication management before and after surgery.

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Review medications with the nurse before surgery. Patients should bring a list of all medications, including vitamins and supplements, to medical appointments and to the hospital. Stop all anti-inflammatory medications, such as Celebrex, Advil, Aleve, or Ibuprofen, herbal preparations and supplements for 7 days prior to surgery. Herbs that patients may take over-the-counter that can increase the chances that you will bleed excessively prior to and after surgery include fish oil, garlic tablets, ginger tablets, ginko, ginsen, vitamin E, quilinggao, feverfew, danshen and chrodroitin. Do not resume anti-inflammatory medications, such as Advil, Aleve, or Ibuprofen, until directed by Dr. Kim, usually 4-5 months post operatively. These medications can slow bone healing. Stop blood thinners, such as Aspirin, Coumadin, or Plavix before surgery. Contact your primary MD or cardiologist for directions to stop blood thinners before surgery. Inform Dr. Kim and Amanda Razo RN if you are on any blood thinners. You cannot have surgery while taking blood thinners. To ensure the success of your surgery, you must stop smoking. Rates of fusion are directly affected by smoking. Shower the night before and morning of the surgery using antibacterial soap. Do not wear any make-up, lotion, or perfume the morning of surgery. Do not eat or drink anything after midnight the night before your surgery. (You may take your scheduled routine medications, such as your blood pressure or heart medications the day of surgery with a small sip of water.) Bring copies of your films or CD, if you have them, with you. Arrange for help at home after surgery by asking family and/or friends. Most patients go directly home following their hospitalization. Arrange transportation home from the hospital.

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On The Day of Surgery:

On the day of the operation you will be asked to arrive approximately 2 hours prior to your operation. You will check in and then be taken to a Waiting Area. Approximately one hour before the operation you will be called to the Holding Area where you will meet the anesthesiologist. The anesthesia staff will then place catheters in your arms for the intravenous fluids and begin to medicate you. The scheduled time of your surgery is really just an approximation. Much depends on the when the last case finished. Sometimes we can be off by more than a few hours. We will do our best to keep you informed of any changes in time.

After Your Surgery:

· Immediately after surgery you will be taken to the recovery room. Following recovery you will go to your private room on the orthopedic floor. Family members are not usually allowed in the recovery room, and the nurse in the recovery room will be in direct contact with your family in the waiting room. You will be able to see your family once you are transferred to your hospital room. · Most patients after cervical spine surgery will be discharged on the following day. Once your drains are out, your medical condition is stable, and your pain is under control with pills; the safest place for you to be is outside of the hospital environment. The hospital is the safest place to be if you are sick, but the less sick you are, the more dangerous it is to be in a hospital. This is because there are "super bugs" in the hospital that do not exist in the community. An infection with one of these "super bugs" can be life threatening. · Bedrest is not good for you. The sooner you get up, mobilize, walk and resume normal activities the lower the chance of developing a blood clot in your legs. The symptoms of a blood clot are swelling, redness and pain in your calves. If you develop these symptoms, please let us know right away. · After surgery ou will have an I.V. with intravenous fluids running into a catheter in your arm. If you need pain medication, please ask one of the floor nurses. You may be switched to pain pills the evening of your surgery

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or the next morning, depending on how your pain is controlled and your ability to swallow. If there is anything we can do to make your hospital stay more comfortable, please do not hesitate to ask. · You will have a drain coming from the incision in your neck: The drain removes the extra fluid from the layers of tissue under your skin. This helps to reduce the swelling in your neck and allows Dr. Kim and the nurses to monitor the amount of blood you have lost. · Don't expect to sleep too much the evening and night of your operation. The surgery allows you to have a several hour nap during the day, which may disturb your wake/sleep cycle. If you are able to get 2-3 hours of sleep the night of the operation, consider yourself lucky. · You will have an x-ray of your cervical spine before you leave the hospital and you will have x-rays taken in the office at 6 weeks post-operatively to assess the fusion. · The morning after surgery you may be up as you desire and tolerate. You may slowly return back to a soft-regular diet. · Dr. Kim will discuss return to work, physical therapy and gradual increase in activities at your first post-operative visit which is typically scheduled 6 weeks after surgery. · If you are given a neck brace post-surgery, use it as directed typically for 612 weeks after surgery. · You should have already been given a prescription for pain medicine at your pre-operative visit with Dr. Kim. If you need any additional medications, you will be given a prescription at the time of your discharge from the hospital. You will need to get this filled on your way home. If no follow up appointment has been scheduled for your six week post operative appointment, within a few days of your discharge, please call our office at 214820-8350.

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Incision Care:

Care of your incision is vital to the success of your surgery. Once you leave the hospital, care of your incision is your responsibility. Please follow these guidelines: · Always wash your hands prior to touching the dressing over your incision. Anyone involved in the care of your incision must wash their hands prior to touching the dressing or incision. · You may shower 48 hours after surgery. Shower with regular soap and water, and pat the incision area dry. DO NOT take a bath or get into a pool until the incision is closed and well healed, this increases the chance for infection. · You will not need to come in to have your sutures removed. Your incision will be closed with absorbable sutures and steri-strips. Leave the steri-strips in place for 14 days after surgery. It may fall off on its own before that time. If you think you are having an allergic reaction to the steri-strips call the office. · The incision can be left open to air. Keep the incision site clean with regular soap and water, and pat the area completely dry. Do not try any ointments or alcohol. · Inspect the incision daily. You may need a mirror to see the incision. · Contact the office if you have: - Redness, swelling, or increased pain around the incision edges - Pus or bad smelling drainage from the wound - Opening of the incision

General Self Care Tips:

· Use supportive thinking and relaxation techniques to help cope with pain. · Walk for 5-15 minutes several times a day. Gradually increase activity as tolerated. Avoid prolonged bed rest. Walking helps the bones to fuse by

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increasing the blood flow to the area of the fusion. Dr. Kim strongly recommends aerobic walking post-operatively. · Stair climbing is allowed; use the hand rails for support. If you have had bone graft taken from your hip, you may not be able to do stairs until the bone graft donor site is healed. · Deep breathing and coughing exercises will help prevent the risk of postoperative pneumonia, especially the first few days after surgery when activity is low. As you increase your activity, these exercises may be lessened. · Eat healthy foods. · Make sure you drink plenty of fluids, eat fruits and vegetables to prevent constipation. · You may need stool softeners after surgery. Anesthesia, pain medications and inactivity can all cause constipation. If you have chronic gastrointestinal conditions, please consult your PCP, internist or gastroenterology physician. Drinking plenty of water (8 eight ounce glasses daily) will help. Other over the counter remedies include: Metamucil, Surfak, Senekot, milk of magnesia, and as a last resort an enema. · Sleep with the head of the bed up at 30 degrees by using pillows or by sleeping in a reclining chair, with the head of the chair in the upright position. You may sleep on either side. Sleeping in the elevated position helps to reduce the swelling in your neck in the first 7-10 days after your surgery. After 7-10 days, you may sleep in a flat position if you are comfortable, but it may be best to slowly decrease your pillow height every few days until you adjust to the flat position. For 6 weeks after surgery: · No bending, extending or twisting the neck. · No lifting greater than 10 pounds. · No lifting overhead. · No reaching overhead for longer than it takes to comb your hair. · No pulling or pushing with your arms.

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· No sexual activity. · Gradual return to prolonged sitting, standing and walking. · In general, driving is okay as long as you are comfortable and not taking narcotic pain medications which affect judgment, reactions and coordination. Please realize operating a motor vehicle may be limited due to your inability to adequately turn your head from side to side, your peripheral vision is very limited.

Why You Should Not Smoke:

It is known that people who smoke are much more likely to need spine surgery than people who don't smoke. Why does this happen? Nicotine decreases the formation of new blood vessels. In addition, it causes a spasm in the small blood vessels that supply parts of your body, such as bones and discs. Because of poor nutrition to the discs and bones, they deteriorate faster; and this results in a higher likelihood of developing ruptured discs, degenerated discs, and arthritis of the spine. A similar process markedly increases the risk of impotence (an inability to maintain an erection for sex) in men. Smokers are twice as likely to develop impotence compared to non-smokers. In addition, smokers are likely to look much older than they would have had they never smoked. Smoking causes premature wrinkle formation. Because it decreases blood supply to the skin, the skin and the tissues underneath the skin dry out much faster, and this leads to wrinkling. If you have a fusion operation on your neck, you should avoid all nicotine products. For the bone to heal, new blood vessels must grow into the dead bone that Dr. Kim has placed inside of your neck. Nicotine prevents the formation of new blood vessels, and therefore, the dead bone stays dead. If the dead bone that Dr. Kim places in your neck does not get fed by new blood vessels, it will stay dead and a fusion will not occur. In most cases this will mean that you will continue to have pain in your neck. Imagine if you broke a bone in your arm and it never healed - every time that you used your arm, it would hurt. Similarly, if the fusion doesn't occur in your neck, it is as though you have a broken bone in your neck that will hurt every time that you move your neck. The pain may become so severe that you will require a second operation to get the bone to heal. If you want to avoid the second operation, you should quit as soon as possible before your surgery, and not take up smoking again until your bone has

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solidly fused. As stated above, one of the reasons why you might need surgery on your neck is because you are a cigarette smoker. If you take up smoking again after your operation, you are much more likely to need yet more surgery on your neck as the other levels in your neck break down. Therefore, we strongly recommend that you quit immediately, and do not take up cigarette smoking again.

The Importance of Aerobic Exercise:

Aerobic exercise is one of the best things that you can do for your entire body. The interesting thing is that it has been shown to markedly decrease chronic pain, including pain from your neck. People who are aerobically fit have much less neck pain than people who are not. Aerobic exercise is any kind of continuous activity that lasts for more than 20 minutes, that increases the blood supply and oxygen delivery to all of your tissues. One way to determine if you are doing this properly is to check your heart rate. Targeted Heart Rate Formula: If you are a formula type person, subtract your age from 220 to get your maximum heart rate. Then multiply this number by .7. This is a reasonable goal for most people. For example, if you are 50 years old: 220-50=170; 170 x .7 = 119. Therefore, the average 50 year old should exercise until their heart rate reaches about 119 beats per minute, and maintain it there for at least 20 minutes. If you are not a formula type person, we recommend that you exercise until you are slightly short of breath and working up a sweat. Maintain this slightly short of breath state for at least 20 minutes. If you have medical problems, you should check with your medical doctor to make sure that you are able to tolerate such aerobic exercise. Start slowly, and keep at it, as you will find significant benefits, not only to your pain but also to the rest of your body. Exercise has been shown to improve mental function, decrease the risk of Alzheimer's, increase stamina and bone density, elevate mood, and add years to your life.

How Does Aerobic Exercise Improve Pain?:

When you exercise, your body puts out chemicals called endorphins. These are naturally occurring morphine-like substances that the body produces in response to pain. This is the substance that probably gives marathon runners a runner's "high". This natural pain killing substance is produced in large amounts in people

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who exercise on a regular basis. In addition, regular aerobic exercise improves your cardiovascular function. Your heart works more efficiently as a pump, and your body begins building new blood vessels to feed the muscles and bones and joints. One of the reasons why you get pain when you have arthritis is that there is not enough oxygen that is delivered to the bones and joints and cartilage inbetween the bones. If you exercise on a regular basis, then oxygen delivery to these arthritic joints is improved, and therefore, the pain is diminished. We have seen many patients who have even avoided surgery on their neck as a result of taking up vigorous aerobic exercise as a means of combating their pain. If you exercise on a regular basis, you will find that you will need less sleep, have more energy, have less pain, and have a better mood. When you stand under a hot shower or get a massage, you also increase the blood supply to your neck. This is why it feels good. However, these are passive ways to increase the blood flow. As soon as the shower or massage stops, the pain quickly returns. The difference with aerobic exercise is that it is an active means of increasing the blood supply, and the effect lasts for hours after you have finished exercising. We recommend elliptical trainers, stationary bicycles, treadmills, and swimming. If you cannot swim, then we recommend that you wear a life vest and run in place in the deep end of the pool. This is excellent exercise, especially for those with arthritis of their hips or knees.

Important Information:

For anterior cervical surgery patients only-(front of your neck)-Your windpipe (which is known as the trachea) and the esophagus (which is the tube that connects the mouth to the stomach),both lie in front of the cervical spine. During the surgery, the trachea and esophagus are gently held to one side so that the vertebrae can be seen. This may be necessary for up to 2 to 3 hours. The movement of the trachea and esophagus may cause a great deal of swelling after surgery. Many people complain after surgery of throat tenderness and pain, a choking type of sensation, and/or a feeling of fullness in their neck. These symptoms will gradually decrease over the next few weeks or months. Your difficulty with swallowing may persist for months after your surgery. Use caution when eating dry foods, large portions of meat or when swallowing large pills. Remember to chew carefully and to take small bites of food. It is very common 4-7 days after

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your surgery for you have an increase in swelling in and around the area of the surgery, especially if Dr. Kim used Bone Morphogenetic Protein. This will usually subside gradually over the next week to two weeks. Sleeping with the head of the bed up at 30 degrees will help to reduce the swelling. SIGNS OF AN EMERGENT SITUATION INCLUDE-If you find in the first 5-7 days after your surgery that you can not swallow even sips of water, you will possibly need to be re-admitted to the hospital for I.V. hydration. This is a very rare occurrence. If you find that in addition to significant swallowing difficulties that the swelling makes it difficult to breathe-you will need to seek emergent care. If at all possible, it is best that you return to Baylor hospital for your emergent care. There is no need for any prophylactic antibiotic therapy before dental work after your neck surgery. We will assume responsibility for completion of any necessary disability forms for patients undergoing surgical procedures. If you are on disability or require completion of disability forms, please complete as much of the disability form as possible prior to your visit, leaving physician signature blank. Provide the form to the office at the time of your visit, or send by mail. The form will be carefully reviewed and signed. Make a copy so you can fill out the future disability paperwork. If the paperwork needs to be faxed, have the fax number available. This will expedite your disability paperwork. Due to the complexity and volume of requests, please allow 7-10 business days for the disability forms to be completed. There is a $25.00 charge for each form that needs to be completed-please include a check with your forms made out to Dr. Youjeong Kim. Should you remain on disability for a time period greater than 1 year post-operatively, you may be referred back to your primary MD for issues related to disability. If medical records from your hospital stay are needed please call Health Information Management at 214-820-2135. If you are requesting medical records pertaining to your office visits please call our office at 214-820-8350. Please be aware that your signature is needed for medical information to be released. For billing information pertaining to your hospital stay, please call 214-820-0111.

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What to Expect Six Weeks After Surgery:

Even though you are six weeks out from surgery you are still not fully healed. If you had surgery on the front of your neck, you will still notice some swallowing difficulties and hardness on the side of your throat. This takes about 3 to 4 months for the soft tissues to get soft again. The swallowing may take up to a year to fully return to normal. If you had a fusion operation, either from the front or the back, the bone takes 4 to 8 months to fully incorporate and heal. Until that time you may still have some aches and pains in your neck and between your shoulder blades. All of this is normal during the healing process. Around 4 to 8 months after the fusion, you may notice a sudden decrease in your pain. That is the day that the bones all fused together and became rock solid. Patients have often described it as a light switch going off. You can hasten this healing period by doing several things: 1) 30-40 minutes of aerobic exercise, 3-4 times per week, which feeds the growing bone with oxygenated blood 2) Avoiding extremes of motion in your neck, since the less you stress it, the faster it heals 3) Don't take Ibuprofen, Aleve, Aspirin or other anti-inflammatory medications, as they all slow down bone healing. You may take Tylenol 4) Don't use any tobacco products If you had weakness in your arms before the surgery, you can do weight lifting exercises now. If you had numbness for more than 3 weeks prior to surgery, it is possible that you still have not noticed an improvement. It often takes weeks to months for numbness to get better, especially if you had constant numbness for a long time before surgery. Until the 1 year mark, we won't be able to tell if the numbness is permanent. Physical therapy is usually prescribed only if needed, 6 weeks after surgery. Please let Dr. Kim know at your 6 week appointment, if you think that physical therapy would be helpful for you.

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EXPLANATION OF CERVICAL SPINE SURGERY

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