ANTERIOR CERVICAL FUSION

You have been diagnosed with a cervical condition requiring a procedure called an Anterior Cervical Fusion (ACF). This surgical procedure requires general anesthesia and you are normally allowed to go home the same day as the procedure or the next morning. Time away from work will depend on the type of work that you do, but we normally advise 2 – 4 weeks. The goal of surgery is to have you return to an active lifestyle without significant pain. You have a 70 – 90% chance of accomplishing these goals after surgery. To increase your chances of a successful operation, you will be asked to do the following:

1. Begin a program of walking after surgery. Walking will help you to heal your fusion in several ways. First, walking is an aerobic exercise; therefore, it will help to increase the oxygen level in your blood.   Increased oxygen means increased nutrition in the fusion, which will increase your success. In addition to adequate nutrition, bone needs a certain amount of stress to grow and become solid. Walking gives your body that stress. Your program of walking will consist of simply walking until you are tired or uncomfortable, and resting until you are ready to walk again. At your 3-week post op visit we hope you will be able to walk 1 – 2 miles per day.

2. Stop smoking, or at the very least, cut down. Smoking robs your blood of oxygen and delays healing which decreases your chance for a successful fusion. Patients who smoke after surgery have a 15 – 25% increase in the failure of the bone to fuse. We understand that it is often difficult to stop a long-term habit. The American cancer Society offers an excellent "STOP SMOKING" program, and they may be reached at 214-631-3862.

Dr. Gill will make an incision approximately 2 – 3 inches on the front neck, right or left side, about 1 – 3 inches above the collar bone. The sutures are placed under the skin to give less noticeable scar. Suture removal may be needed at 2 weeks post op. There will be a clear tegaderm dressing over the incision that should stay on until your first office visit at 2 weeks after surgery.  

Dr. Gill will use synthetic bone, bone bank bone (allograft), or your own pelvic bone (rarely), to use for the fusion. Dr. Gill will use a titanium plate only a few millimeters thick to provide stabilization while the bone is healing. This instrumentation prevents bone graft collapse or extrusion and improves fusion success.

When you awaken from surgery, you will have a hard neck brace on until you are awake and alert. It may then be removed; however, this brace must be worn in the car for about 6 weeks. Please note: If you have front and side air bags, the brace does not need to be worn while in the car.   Your body will need 12 weeks to fuse the bone as if it were healing a fracture. You will have x-rays taken in the office usually at 6 weeks to assess the fusion and then again at a 4-month post op office visit.

When you are discharged from the hospital, you will have absorbable sutures under your skin holding the incision closed. On the top of the skin will be steri-strips covered by a clear plastic tegaderm. See the WOUND CARE information sheet.

If you smoke, are diabetic, or if you are 30 – 40 pounds over your ideal body weight, you may experience more difficulty after surgery with the healing process. You will be given a list of your scheduled post op appointments.

An important point to understand is that pain is normal with a healing fusion. The pain can vary from minimal to severe. An increase in pain does not necessarily mean that something is wrong. You may experience severe muscle spasms between your shoulder blades or in your shoulder and neck muscles. This is normal.

If you live alone, you may want to arrange things at home for easy accessibility prior to surgery. Example: moving dishes, towels, etc., from top and bottom shelves to waist level. You will want to limit most activity above shoulder height.

AFTER SURGERY

Wear the neck brace at all times while in the car unless you have front and side air bags in the automobile in which you are riding.

There is usually no restriction on driving unless you find it difficult while wearing the brace, or you are taking narcotics that affect your judgment, reactions and coordination. After surgery, we will advise you as to when you may start driving.

Do not lift over 10 pounds for 6 weeks - especially above shoulder height.

Walk to help maintain your energy level.

You may shower - blot the tegaderm dressing dry after you shower. If water gets under the tegaderm dressing, call the office.

If you have difficulty sleeping, you may want to purchase a cervical pillow from a medical supply store. We can provide a prescription for this pillow for possible insurance reimbursement.

Depending on your activity level, rate of healing, and pain tolerance, Dr. Gill will determine when you may return to work.

You will be seen in the office after surgery:
… 2 weeks after surgery - to check your incision.
… 6 weeks after surgery - for x-rays and to check progress of the fusion.
… 4 months after surgery – for x-rays and to check progress of the fusion.

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