ACDF and Cervical Disk Replacement Surgery Packet
We welcome you to the Excel Spine Center family and thank you for choosing us for your upcoming surgical procedure. Our team considers patient satisfaction to be of the upmost importance and we intend to exceed your expectations during this experience. As a leader in minimally invasive spine surgery, we take pride in offering the finest and most advanced spine care available. Our procedures offer the following benefits compared to traditional open spine surgery:
• Less muscle and tissue damage
• Decreased blood loss
• Reduced post-operative infection rate
• Less post-operative pain
• Shorter hospital stays
• Smaller scars
• Faster recovery time
• Quicker return to daily activities
You are the most important member of our team and are encouraged to take an active role in preparing for your surgery and recovery. You can make your surgical outcome safer and more successful if you are active, involved, well informed, and carefully follow your schedule and instructions.
Please take the time to carefully read this entire packet in order to understand your role in ensuring effective preparation and a smooth recovery. The enclosed information explains the logistics of your upcoming operation, and outlines what you need to do before, during, and after surgery. We highly recommend that you use this guide as a step-by-step tool throughout the entire surgery process. We also urge you to share this information your family/friends who will be helping you prior to surgery and throughout your recovery. Please note: This packet is just a guide. Dr. Kim may give you different or additional instructions that are specific to your condition or procedure.
If you have any additional questions or concerns, please do not hesitate to contact us. We understand that undergoing a surgical procedure can be a stressful and hectic time for you and your family, and we are here to help you! Once again, thank you for choosing us for your spine care.
Dr. Choll Kim and Team
What happens next? Kelsey, our surgery scheduler, will request authorization from your insurance company and will contact you as soon as she hears from them; this normally takes about 5-7 business days. In the meantime, please complete your pre-operative (aka pre-op) clearance tests and schedule an appointment with your primary care physician (PCP) as soon as possible.
1. PRE-OPERATIVE APPOINTMENT WITH YOUR PRIMARY CARE PHYSICIAN
Please schedule an appointment with your PCP as soon as possible for a medical history and physical exam. Your PCP will review the results of your pre-op tests and determine if you are healthy enough to undergo spine surgery. Please email Kelsey at Kelsey@excelspine.com when you have scheduled this appointment to give her a better idea of when to expect the results and the medical clearance note. Also, please ask your doctor to fax a copy of your medical clearance note to our office at: (619) 333-6029. If you have other active medical problems, you may need to also obtain clearance from a specialist (cardiologist is the most common).
2. PRE-OPERATIVE APPOINTMENT WITH DR.KIM
As soon as Kelsey receives authorization from your insurance company, she will contact you to choose a date for your surgery and to schedule your pre-op appointment with Dr. Kim, which will take place 1-2 weeks prior to surgery. She will also mail and email you a letter outlining these dates, in addition to other important information. We will be mailing you consent forms; please review, sign and bring these with you to your pre-op appointment with Dr. Kim. If there are any parts of the consent that you wish to discuss prior to signing, please contact our office before your pre-op appointment. During this appointment, you will go over your treatment “pathway” (also known as the “road to recovery”) and you will be given instructions for medications to take after surgery. Please email any questions or concerns to Kelsey at Kelsey@excelspine.com ahead of time; we want to ensure that Dr. Kim answers all your questions and addresses any concerns during this appointment.
3. PRE-ADMISSION APPOINTMENT WITH THE HOSPITAL/ SURGERY CENTER
If a hospital pre-admission appointment is needed, Kelsey will schedule it to take place on the same day as your pre-op appointment with Dr. Kim. During this appointment, you will verify your contact information and insurance. A nurse will also provide you with special antibacterial soap, instructions for the morning of surgery, and answer any questions regarding your hospital stay. Please bring a complete list of your allergies and medications, including the dosage, how often you take it, and the reason for the medication.
Please email a complete list of your allergies and medications (prescription and non-prescription), including the dosage, how often you take it, and the reason for the medication, to Kelsey@excelspine.com. Some medications can affect blood clotting and increase the risk of excessive bleeding during and after surgery. Please follow these instructions for your safety and to avoid cancellation of your procedure. You should, however, NOT discontinue the bold medicines below without clearance from the provider who prescribes them (PCP/hematologist/cardiologist).
30 DAYS PRIOR TO SURGERY, DISCONTINUE:
7 DAYS PRIOR TO SURGERY, DISCONTINUE:
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as Mobic/Meloxicam, Motrin/Ibuprofen/Advil, Naproxen/Naprosyn/Aleve, Ketorolac, Voltaren/Diclofenac, Celebrex (Note: Tramadol, and Tylenol/Acetaminophen are ok to take for pain control during this time)
- Oral naltrexone (Do not restart this medication after surgery until you have discontinued all opioid pain medications [including Tramadol] for at least 7-10 days)
- If you take a GLP-1 Agonist weekly, stop 1 week prior to surgery. These include: Dulagutide/Trulicity, Exenatide/Byetta or Bydureon, Liraglutide/Saxenda or Victoza, Lixisenatide/Adlyxin, Semaglutide/Ozempic/Wegovy/Rybelsus
5 DAYS PRIOR TO SURGERY, DISCONTINUE:
- Plavix/Clopidogrel (Restart 72 hours after surgery)
2 DAYS PRIOR TO SURGERY, DISCONTINUE:
- Eliquis/Apixaban (Restart 72 hours after surgery)
- Xarelto/Rivaroxaban (Restart 72 hours after surgery)
THE DAY BEFORE SURGERY, DISCONTINUE:
- If you take a GLP-1 Agonist daily, stop 1 day prior to surgery. These include: Dulagutide/Trulicity, Exenatide/Byetta or Bydureon, Liraglutide/Saxenda or Victoza, Lixisenatide/Adlyxin, Semaglutide/Ozempic/Wegovy/Rybelsus.
DO NOT TAKE THESE MEDICATIONS AFTER 5PM THE NIGHT BEFORE SURGERY, OR THE MORNING OF SURGERY:
- ACE inhibitors (Lisinopril, Captopril, Enalapril, Sacubitril)
- Angiotensin II Receptor Blockers/ARBs (Losartan, Valsartan, Candesartan, Irbesartan)
ON THE NIGHT BEFORE SURGERY, DO NOT EAT OR DRINK AFTER MIDNIGHT.
- This includes gum and candy. It is ok to brush your teeth the morning of surgery and take medicine with a small sip of water, but do not drink a full cup.
FAMILY, FRIEND OR CAREGIVER SUPPORT
A family member, close friend or other designated caregiver will become an important member of your extended team to help you prior to surgery and throughout your recovery. Please introduce these individuals to Dr. Kim. Please also make arrangements to have a family member or friend drive you home from the hospital, stay with you for the first few days at home and drive you to your post-op appointment with Dr. Kim. If this is a problem, please notify our office.
BEFORE THE PROCEDURE
- Please arrive at the hospital/facility at the time directed by the hospital/facility. This is usually 2 hours prior to your scheduled surgery.
- Remain NPO (no food and no water) as instructed.
- After checking in, you will be asked to complete any remaining admission or consent forms.
- You will then be escorted to the pre-operative holding area to be prepared for your surgery.
- You will be asked to change into a hospital gown.
- An IV line will be started and an initial set of vital signs will be taken.
- The anesthesiologist will review your chart and answer any of your questions.
- Dr. Kim will meet with you to answer any last-minute questions and exchange/verify contact information with you and your family and/or friends.
DURING THE PROCEDURE
- When the surgical team is ready, you will be taken to the operating room.
- The anesthesiologist will manage your vital signs and adjust your anesthetic as needed to ensure your comfort and safety throughout the entire time you are in the operating room.
- While you are sleeping, a small tube, called a Foley catheter, may be inserted into your bladder to drain urine during your surgery. This catheter is either removed while still in the operating room or may remain in place until you are up and out of bed if you are expected to stay in the hospital overnight. Foley catheters are usually not needed for cervical surgeries unless your surgery is expected to last more than 4 hours.
- A neuromonitoring technician will apply electrodes to your arms and legs to monitor nerves intraoperatively.
- The surgical team will prepare you and place drapes to ensure a sterile environment.
- The total time required for surgery differs from patient to patient depending on the complexity of the procedure.
AFTER THE PROCEDURE
- You will be taken to a recovery area where you will remain for 1-2 hours.
- Dr. Kim will update your friends and/or family.
- You may feel groggy from the anesthesia.
- A nurse will monitor your vital signs and check your pain level. You should tell the nurse when it hurts, where it hurts and how much it hurts on a pain scale of 0-10.
- You will then either go home the same day or be taken to the Spine Unit to begin the post-operative and rehabilitation phase of your recovery. Guests can see you in your room at this time.
- NOTE: Most patients go home the same day after surgery for cervical surgeries.
- After your surgery, the nursing and surgery teams will closely monitor you.
- Generally, each day starts with a blood draw for routine monitoring.
- You will be introduced to physical therapists. The two of you will work together to achieve important goals outlined in the treatment “pathway” (also known as the “Journey to Recovery”), which was given to you at your pre-op appointment with Dr. Kim. These goals include regaining independence and mobility, developing a program for walking at home, and understanding proper body mechanics and spine precautions.
- A provider from Excel Spine Center will visit you.
LENGTH OF STAY
Your stay at the hospital will depend on your individual condition, your tolerance to pain medication, and the extent of your surgery. Your individualized treatment “pathway” (also known as the “Journey to Recovery”) will outline your plan of care during your hospital stay. Most patients go straight home but some patients may need to recover in a skilled nursing facility (SNF) about 1-3 days after surgery.
After 3 days, remove the dressing and leave the incision open to air. Wash your hands before and after caring for your incision. Your incision has medical glue that dries purple and acts like a barrier to protect your incision. Let the glue flake off over the next few weeks; do not pick at the flakes. Do not apply creams, lotions, or ointments to the incision for the first 6 weeks. To avoid infection or scarring, do not scratch or scrub the incision. Please notify us of any discharge from the wound and email a photo of your wound and dressing if this occurs to Choll@excelspine.com, or call us. Please include the time of your last dressing change in the email so we can assess the quantity of discharge and recommend appropriate wound care. If you have been prescribed antibiotics, finish the entire prescription as directed.
- Change positions at least every 30-45 minutes.
- Stay active throughout the day, taking breaks when necessary.
- Take pain medication as directed and at least 30 minutes before planned activity or exercise.
- Apply a covered ice pack 2-3 times a day, for 15- 20 minute intervals to help swelling or discomfort.
- Use relaxation techniques such as meditation, deep breathing, reading or listening to music.
- Perform simple stretches and gentle range of motion exercises. See our YouTube Video on gentle neck exercises that may be started before physical therapy: https://www.youtube.com/watch?v=E5cCa8eP
This will depend on the extent of your surgery, your recovery process and the specific requirements of your job. If you have a relatively sedentary job and can comfortably sit, you may resume working around 2-4 weeks after surgery. If your job is physically demanding, and you are able to perform controlled exercises and lift weights, you may return to work around 6-8 weeks after surgery; however, more time may be needed. Dr. Kim recommends returning to work on a part-time basis with limited duties before returning to full-time work without any restrictions. If you need to take time off work, please contact your employer for FMLA forms. For more information about FMLA, visit: www.dol.gov/whd/fmla/.
If you experience any of the following symptoms:
- Persistent, severe or uncontrollable pain
- Worsening weakness or numbness in your extremities
- Incisional redness, drainage, or increased swelling
- Difficulty breathing, fevers, or chills
- Problems controlling your bladder or bowel
- No bowel movement for 3-5 days
- Calf or lower leg swelling
Following cervical surgery
1-2 WEEKS AFTER SURGERY
- Take several short walks and perform posture exercises throughout the day.
- Drink six, 8 oz. glasses of water per day, and eat fresh fruits and vegetables high in fiber.
- Do not participate in sports or activities that require frequent or strenuous bending, twisting, pushing or pulling.
- Limit initial car rides to short, local distances (around 1 hour or less).
- Do not lift more than 10 pounds (a gallon of milk weighs about 9 pounds) until 4 weeks post-op.
3-4 WEEKS AFTER SURGERY
- Start physical therapy.
- Try to stop wearing your collar, if applicable.
- You can resume intercourse, as tolerated.
- Wean off all narcotic pain medications and transition to Tylenol/Acetaminophen as needed.
- If you are no longer taking any narcotic pain medication, you may start driving.
- You may go on longer car rides and take short, local flights.
- If you have a relatively sedentary job, you may likely return to work. Let pain be your guide for this.
5-6 WEEKS AFTER SURGERY
- Do not lift more than 25-30 pounds.
- You may perform light chores, such as cooking, dusting, sweeping or folding laundry.
- You may participate in non-contact sports and activities such as yoga, hiking or cycling.
3 MONTHS AFTER SURGERY
- Gradually increase activities as tolerated by pain.
- You may perform household chores, such as gardening and mowing the lawn, as tolerated by pain.
- You may participate in more non-contact sports and activities such as running, golfing or tennis.
- You may start taking frequent or long-distance flights.
- If your job is physically demanding, you may likely return to work.
Q: What if I’m not ready to proceed with surgery?
A: You should never feel pressured to proceed with surgery. If you are unsure, we encourage you to review our educational materials, get a second opinion, speak to one or more of our previous surgery patients, or talk with your family and friends.
Q: What can I do before my surgery to help with my recovery? (See page titled “Preparing for Surgery”)
A: Dr. Kim recommends maintaining a healthy diet and getting a sufficient amount of sleep each night to strengthen your immune system. You should continue to perform simple stretches and exercises that increase
flexibility and strengthen muscles. Keeping your muscles toned and endurance high will help you to recover faster after surgery. Also, try to reduce alcohol consumption and try to stop smoking, or cut back on the number of cigarettes you smoke each day.
Q: Why should I quit smoking prior to surgery?
A: You should try to stop smoking or cut back on the number of cigarettes you smoke each day, in order to help your bones fuse, wound heal, and minimize the risk of infection. There is a higher chance your fusion will not heal if you continue to smoke because smoking disrupts the normal function of the body’s system, decreases blood flow to healing tissues, limits bone growth and accelerates arthritic changes. Stopping even for a short period of time will be helpful.
Q: Will I see Dr. Kim or a Physician Assistant if I stay overnight in the hospital? (See page titled “Day of Surgery”) A: Yes! Dr. Kim or one of our Physician Assistants will visit you.
Q: When will I be able to return to my normal activities? (See page titled “After Surgery Do’s and Don’ts”)
A: Dr. Kim utilizes minimally invasive techniques during spine surgery, which results in a smaller incision and less muscle and tissue damage. Therefore, you can expect to experience less post-operative pain, shorter hospital
stays, a faster recovery time, and an earlier return to work and daily activities than is associated with traditional open back surgery. Nonetheless, it is still surgery. While most procedures successfully relieve pain and improve function, recovery does take time. Returning to your normal activities will be a slow process. Each surgery is different, and the healing and recovery time will vary.