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C-spine surgery
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C-spine surgery


  I originally posted on Nov. 24th of last year, and this is a question related to treatment based on that follow-up MRI......firstly, the original MRI showed nerve root compression at C-5,6 and proximity to the cord of the disc at C-4,5 but no compression and no demonstrable deficits.  On that basis, my original surgery was a simple discectomy with iliac crest bone graft........My surgeons decision at that time was for the simpler procedure.....The repeat MRI showed that some compression was now occuring at C-4,5, and that the bone graft from the original surgery had shifted.  I had a repeat procedure in late December, and this time, the surgeon removed the vertebral bodies of C-4,5, removal of the old graft, with replacement, and insertion of a titanium plate anchored to the vertebral bodies of C3 and C6........My questions are as follows:  first, I have a hemagioma in the vertebral body of C6, which my surgeon mentioned developed some venous bleeding while anchoring the plate......any potential problems from that?  Secondly, I've been getting conflicting opinions as to the length of recovery......when further questioned, the response from the resident was that different surgeons have different protocols.  The resident said I need to wear a cervical collar full time for at least 6 weeks, and part time (off at night) for another six weeks, whereas my surgeon says 3-4 and I can take it off part time after 2, as long as I'm careful.  THis is a wide range of recovery time, and I have to get back to work, but don't want to do so too quickly and jeopardize the repair.  I am an ICU nurse, and as you well know, it's a physically demanding job.  My surgeon is not pushing me at all to get back to work, and feels quite badly about not doing the larger procedure initially, so will pretty much do what makes me comfortable.  So, to make a long story short, what is your consensus, and/or protocol for recovery time after this procedure, keeping in mind the type of work I do?
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Dear Evelyn,
The resident you spoke to is correct.  There are many different ways to manage patients after this kind of surgery.  We typically keep a patient in a collar for six weeks and check c-spine films before the collar is removed.  This has been successful for our practice.  Some would argue that, with a plate, the collar may be taken off earlier.  This, too, is reasonable.  
A fusion procedure, whether in the cervical, thoracic or lumbar spine, will take up a year to heal completely.  There is an early fusion mass by six weeks, but the bone has not fused completely and has not begun the normal process of remodelling that happens in all of our bones.
There is no absolute number of weeks that a collar must be worn after a cervical corpectomy and fusion.  The bottom line for you should be to take it easy after surgery and realize that you cannot stress your neck like you used to.  Perhaps you could go back to work on light duty for a period of time.  
All of these issues should be settled between you and your surgeon, as this is a personal management issue for each surgeon.
Good luck.






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