There are a lot of ways anterior cervical discectomy and fusion (ACDF) surgery can go wrong. Some of the common problems are certainly not the patient's fault. The surgery can leave you hoarse and experiencing difficulty swallowing for several weeks. That's to be expected when a surgeon opens your throat. Even after you have the surgery, your pain may persist. That's usually because the ruptured disk pressed on a nerve that didn't bounce back into its correct placement. The effect is a little like the permanent dents furniture leaves on a carpet. They don't easily go away. These problems are inherent with the disease.
There are also potential complications of ACDF surgery that patients can influence. The number one preventable complication of the surgery is failure for the disks or bone grafts to fuse because the patient smokes. If you happen to be getting a bone graft with pins and screws, actually smoking doesn't produce measurable increases in the rates of disk failure after surgery. However, smokers are more than twice as likely to have problems with swallowing (dysphagia) after the surgery, and they are also more likely to need revision surgery after the first procedure. Among smokers who have to have revision surgery, dysphagia is a problem for more than 70 percent. However tired you may be of people nagging you not to smoke, really, if you have ACDF surgery, you shouldn't smoke.
Another set of preventable problems after ACDF surgery arises from not following the doctor's instructions:
- It's very, very important not to expose the incision site to water before your doctor tells you it is safe to do so. That means no tub baths, no hot tub, no swimming pool, not even a shower until the doctor confirms that the incision has begun to heal. You want to contact your doctor immediately if you experience fever, oozing, draining, or new pain or redness at the site of the surgery during the first two weeks.
- The doctor will tell you not to take NSAID (non-steroidal anti-inflammatory medications, such as Aspirin, Tylenol, and Ibuprofen) for pain for at least six weeks after your surgery. One reason to avoid these medications is that they increase the rate of bleeding, which can make it harder for your incision to heal. They also interfere with the formation of cartilage around your spine that holds the new disk in place.
- When the doctor tells you not to lift anything that weighs more than 5 pounds (a little of 2 kilos), that also means no washing and drying dishes, no stacking the dishwasher, no carrying groceries, no making up the bed, no vacuuming, no mowing the lawn, and no driving until you are told those activities are safe. Your spine cannot heal if you constantly aggravate it.
- Nodding your head may hurt. Most sexual activities just can't be done for a while.
- You'll need a cervical collar when you walk and, later, when you have been told it is safe to drive your car. You should get the collar and instructions in how to use while you are still at the hospital. Don't leave the hospital without it.
- Even when you're well, you will have to lift heavy objects the "right way," which your doctor should arrange for you to be taught, to avoid future injury.
There can also be complications with pain management. Many doctors treat post-surgical pain with epidural injections of steroids. The doctor uses a long needle (which you won't have to see) to inject steroid medication into the space around the spinal nerve. What you need to know is that if you get these shots within the first six months after your surgery, your risk of infections goes substantially up, about double. Getting an epidural doesn't mean you absolutely, positively will get an infection, but it does mean you need to take all prescribed precautions to make sure that you don't.
A lot of people do everything right and still have unbearable pain after ACDF surgery. Sometimes the surgery just doesn't "take." There may have to be a second, revision surgery. Just be sure to be just as careful, or even more, second time as you were the first.
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