Recovery After Posterior Cervical Decompression & Fusion
What to Expect After Surgery
A posterior cervical decompression and fusion is performed through the back of the neck to relieve pressure on the spinal cord and/or nerves and stabilize the cervical spine.
Recovery after a posterior cervical fusion is different from recovery after surgery performed through the front of the neck.
Because we work through the muscles along the back of the neck, muscle soreness, tightness and fatigue can be more noticeable during the early stages of recovery. The posterior incision also needs time to heal.
My goal is still to get you up, walking and moving—but during the early recovery period, I want you to be particularly careful about activities that place unnecessary stress across the back of your neck and your incision.
My Approach to Recovery
Walk Early and Often
Walking is one of the most important activities you can do after posterior cervical surgery.
I want you up and moving rather than spending your recovery in bed.
Start with shorter, frequent walks throughout the day. As your strength and endurance improve, gradually increase your distance.
You don't need to achieve a specific number of steps.
Walk consistently and increase your activity as your body allows.
Protect the Back of Your Neck
The posterior incision and underlying muscles need time to heal.
During the early recovery period, I want you to avoid placing unnecessary stress across the back of your neck.
In particular, avoid:
Overhead lifting
Heavy pushing
Heavy pulling
Strenuous upper-body activity
Activities that cause significant strain across the posterior neck or incision
This doesn't mean you shouldn't move.
I want you walking and performing appropriate everyday activities while protecting the healing tissues in the back of your neck.
Your Incision Is Important
The incision after a posterior cervical fusion deserves particular attention during recovery.
Avoid activities that pull, stretch or place excessive tension across the incision.
Depending on your surgery and how your incision is healing, I may close the incision with staples or sutures.
Staples or Sutures May Stay in Longer Than You Expect
Don't be concerned if your staples or sutures aren't removed immediately.
Depending on how your incision looks and how you're healing, I may leave staples or sutures in place for up to approximately four weeks.
I would rather give the posterior incision adequate time to heal than remove them simply because a certain number of days has passed.
Your incision will be evaluated during follow-up, and removal will be based on how it is actually healing.
When Can I Remove My Bandage?
Keep your surgical bandage in place for the first 4–5 days after surgery, unless you are given different instructions. After 4–5 days, remove the original bandage and replace it with a clean, new bandage. Continue to keep the incision covered until your postoperative follow-up. If the bandage becomes wet or soaked with drainage at any time, replace it with a clean, dry bandage and contact your surgical team. Do not leave a wet or saturated dressing over the incision. Your individual wound-care instructions may vary depending on your incision and how it was closed.
Your First Few Days
During the first several days after surgery, it is common to experience:
Soreness along the back of the neck
Muscle tightness or spasms
Shoulder and upper-back discomfort
Incisional soreness
Fatigue
Difficulty finding a comfortable sleeping position
Residual arm numbness or tingling
Persistent neurologic symptoms that may take time to improve
Posterior cervical surgery involves the muscles along the back of the neck, so muscular discomfort can be significant early in recovery.
This should progressively improve.
Your First Week
Your priorities during the first week are straightforward:
Walk. Protect your incision. Allow your body to heal.
Take several short walks throughout the day.
Change positions periodically rather than remaining in bed or a chair for long periods.
Avoid overhead lifting and strenuous pushing or pulling.
Pay attention to your incision.
Rest when you need to. Fatigue after a significant cervical operation is normal.
You don't need to prove how quickly you can recover.
Weeks 2–6
During the next several weeks, you should gradually become more active as your discomfort improves.
Walking distances can increase and normal daily activities can progressively return.
However, feeling better does not necessarily mean that the posterior tissues or fusion have completely healed.
Continue protecting the posterior incision and avoid activities that place excessive strain across the back of your neck until I have progressed your restrictions.
Your incision will also continue to be monitored. Staples or sutures may remain in place longer when I believe the incision would benefit from additional healing time.
Weeks 6–12 and Beyond
As healing progresses, we can begin discussing a more substantial return to exercise, work and recreational activities.
The exact progression depends on:
The number of levels treated
Your reason for surgery
Your neurologic recovery
Your incision
Your strength and endurance
How the fusion is progressing
The physical demands of the activities you want to resume
A multilevel posterior cervical fusion is a significant operation.
Recovery is a progression—not a race.
Getting Back to Life
One of my goals is to help you understand not only how your surgery was performed, but what you can actually do afterward.
When Can I Walk?
Right away.
Walking is encouraged early after surgery.
Start with shorter walks and gradually increase the distance and duration as your endurance improves.
Walking should become part of your daily recovery.
When Can I Drive?
Driving is based more on your ability to drive safely than simply reaching a particular postoperative date.
Before driving, you should:
No longer be taking narcotic or other medications that impair your ability to drive
Be comfortable sitting behind the wheel
Have adequate ability to safely see your surroundings
Be able to safely control the vehicle and react in an emergency
A posterior cervical fusion—particularly a multilevel fusion—can permanently change the amount of motion available in your neck. You need to be able to compensate safely for that change before returning to driving.
If you're unsure whether you're ready, ask me at your follow-up visit.
When Can I Return to Work?
This depends heavily on what you do.
Desk or sedentary work
Patients may be able to return earlier when pain is controlled, energy is improving and they can comfortably sit and change positions as needed.
Physical work
Jobs requiring overhead activity, lifting, pushing, pulling or significant upper-body exertion generally require more time.
Because these activities can place stress across the posterior neck, I will progress your work restrictions based on your recovery and the demands of your job.
When Can I Lift?
During the early recovery period, avoid heavy lifting and particularly avoid lifting overhead.
Something that seems relatively light can still create substantial strain when held away from your body or above your head.
Keep necessary objects close to your body and avoid activities that make you feel significant pulling or strain across the back of your neck.
Heavier lifting will be progressively reintroduced as you heal.
When Can I Push or Pull?
Heavy pushing and pulling should be avoided during early recovery.
That includes more than exercise equipment.
Be careful with activities such as:
Moving furniture
Pushing heavy doors or objects
Pulling heavy carts
Strenuous vacuuming or yardwork
Heavy upper-body exercise
If you feel yourself significantly straining through your shoulders and the back of your neck, the activity is probably too aggressive for the early recovery period.
When Can I Exercise?
Walking is your primary early exercise.
More strenuous exercise is added progressively.
During early recovery, avoid upper-body exercises that require heavy pushing, pulling or overhead lifting.
As your incision heals and your recovery progresses, we'll discuss when and how to reintroduce strengthening and more strenuous cardiovascular exercise.
When Can I Swim or Get in a Pool?
Do not submerge your incision until it has completely healed and you have been cleared to do so.
This means avoiding:
Swimming pools
Hot tubs
Lakes
Baths or other situations where the incision is submerged
This is particularly important while staples or sutures remain in place or if there is any area of the incision that has not completely healed.
Once the incision is healed and you've been cleared, water activities can be progressively resumed.
When Can I Travel?
You can generally be a passenger when you are comfortable enough to travel.
For longer trips, avoid remaining in one position for prolonged periods. Stop periodically during car trips to stand and walk.
If you're planning a long flight or significant travel soon after surgery, discuss it with me beforehand.
When Can I Return to Golf or Sports?
Return to sports after posterior cervical fusion is more individualized than after many less invasive cervical procedures.
The number of levels fused, your remaining cervical motion, neurologic condition and demands of your particular sport all matter.
We will progressively determine which activities are appropriate as your recovery advances.
What's Normal During Recovery?
After posterior cervical fusion, you may experience:
Neck and shoulder soreness
Muscular pain along the back of the neck is common because these tissues were involved in the surgical approach.
Muscle spasms
The posterior cervical and shoulder muscles may feel tight or spasm during early recovery.
Fatigue
Major spine surgery can temporarily decrease your energy considerably. Your endurance should gradually return.
Incisional sensitivity
The back of your neck may remain tender or sensitive as the incision heals.
Numbness or tingling
Nerve symptoms don't always disappear immediately after decompression.
Weakness or balance problems that take time to recover
When surgery is performed because of spinal cord or nerve compression, neurologic recovery can continue over a much longer period than the surgical incision takes to heal.
The purpose of decompression is to remove pressure from the spinal cord and nerves and give them the best opportunity to recover.
When Should I Call?
Please contact the office if you notice:
Increasing redness around the incision
Increasing swelling
New or increasing drainage
Separation or opening of the incision
Fever or other signs of infection
Significant worsening of pain
New or progressive weakness
New or significantly worsening numbness
A significant change in your neurologic symptoms
Any postoperative change that concerns you
Because the posterior incision is particularly important, please contact us rather than waiting if you are concerned about how it looks or how it is healing.
Seek immediate emergency medical attention for difficulty breathing, sudden severe weakness or paralysis, loss of consciousness, chest pain, loss of bowel or bladder control associated with new neurologic symptoms, or another potentially life-threatening problem.
Move—But Protect What Is Healing
My philosophy after posterior cervical fusion is not bed rest.
I want you walking. I want you moving. And I want you gradually returning to your normal life.
At the same time, the muscles and incision along the back of your neck need time to heal.
During the early recovery period, the balance is simple:
Keep moving, but avoid unnecessary stress across the posterior neck.
Protect the incision. Avoid overhead lifting and strenuous pushing or pulling. Walk frequently. Gradually increase your activity.
As your incision, muscles and fusion heal, we'll progressively work toward getting you back to the activities that matter to you.
These guidelines describe my general approach following an uncomplicated posterior cervical decompression and fusion. Your diagnosis, neurologic condition, number of levels treated, wound healing and other medical factors may require different instructions. Always follow the individualized postoperative instructions provided to you.