What is it?

Pain in the neck and extremities, among other symptoms, may occur when an intervertebral disc herniates - when the annulus fibrosus (tough, outer ring) of the disc tears and the nucleus pulposus (soft jelly-like center) squeezes out and places pressure on neural structures, such as nerve roots or the spinal cord. Bony outgrowths, called bone spurs or osteophytes, which form when the joints of the spine calcify, may also cause these symptoms.

Anterior cervical discectomy is an operation that involves relieving the pressure placed on nerve roots and/or the spinal cord by a herniated disc or bone spurs - a condition referred to as neural compression.

Through a small incision made near the front of the neck (i.e., the anterior cervical spine), the surgeon removes disc material and/or a portion of the bone around the nerve roots and/or spinal cord to relieve these compressed neural structures and to give them additional space.

Discectomy involves removing all or part of an intervertebral disc. The term discectomy is derived from the Latin words discus (flat, circular object or plate) and -ectomy (removal).

Why is it done?

Pressure placed on neural structures, such as nerve roots or the spinal cord, by a herniated disc or bone spur may irritate these neural structures and cause: pain in the neck and/or arms; and lack of coordination, numbness or weakness in the arms, forearms or fingers. Pressure placed on the spinal cord as it passes through the neck (cervical spine) can be serious since most the nerves for rest of the body (e.g., arms, chest, abdomen, legs) have to pass through the neck from the brain.

Patients who suffer from these symptoms are potential candidates for this operation.

The Operation

An understanding of what an anterior cervical discectomy involves will help you to approach your operation and recovery with confidence.

Incision

The operation is performed with you lying on your back. A small incision is made to one side of the front of your neck.

Exposure

After pulling aside the soft tissue - fat and muscle, your surgeon exposes the source of the neural compression.

Removal

Disc material - and, in some cases, a portion of the bone - around the nerve roots and/or spinal cord is then removed to relieve the compressed neural structures and to give them additional space.

Closure

The operation is completed when your surgeon closes and dresses the incision.

Recovery

Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible. The amount of time that you have to stay in the hospital will depend on this treatment plan. You will normally be up and walking in the hospital by the end of the first day after the surgery.

As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.

Anterior cervical discectomy with fusion is a surgical procedure that involves relieving the pressure placed on nerve roots and/or the spinal cord by a herniated disc or bone spurs in the neck - a condition referred to as nerve root compression.

What Is Anterior Cervical Discectomy With Fusion?

Cervical refers to the 7 vertebrae of the neck. Discs are the spongy, cartilaginous pads between each vertebra, and ectomy means “to take out”. In a cervical discectomy, the surgeon accesses the cervical spine through a small incision in the neck and removes all or part of the disc - and/or in some cases bone material - that’s pressing on the nerves and causing pain.

Spinal fusion involves placing bone graft between two or more affected vertebrae to promote bone growth between the vertebral bodies. The graft material acts as a binding medium and also helps maintain normal disc height – as the body heals, the vertebral bone and bone graft eventually grow together to join the vertebrae and stabilize the spine.

Why Do I Need This Procedure?

If you have a herniated disc, this means that the nucleus pulposus – the soft, gel-like center of the disc - has pushed through the annulus fibrosus, the disc’s tough, outer ring. Bone spurs, also called osteophytes, can form when the joints of the spine calcify.

Pressure placed on nerve roots, ligaments or the spinal cord by a herniated disc or bone spur may cause:

• Pain in the neck and/or arms
• Lack of coordination
• Numbness or weakness in the arms, forearms or fingers.

Pressure placed on the spinal cord as it passes through the cervical spine can be serious, since most of the nerves for rest of the body (e.g., arms, chest, abdomen, legs) must pass through the neck from the brain. A cervical discectomy can ease pressure on the nerves, ultimately providing pain relief.

An anterior cervical discectomy with spinal fusion is typically recommended only after non-surgical treatment methods fail. Your surgeon will take a number of factors into consideration before making this recommendation, including the condition to be treated, your age, health and lifestyle and your anticipated level of activity following surgery. Please discuss this treatment option thoroughly with your spinal care provider.

How Is An Anterior Cervical Discectomy With Fusion Performed?

Through a small incision made near the front of the neck, the surgeon:

• Removes the intervertebral disc to access the compressed neural structures;
• Relieves the pressure by removing the source of the compression;
• Places a bone graft between the adjacent vertebrae; and
• In some cases, uses instrumentation – metal plates or pins that will provide extra support and stability to help ensure properfusion.

How Long Will It Take Me To Recover?

Your surgeon will have a specific post-operative recovery/exercise plan to help you return to your normal activity level as soon as possible. The amount of time that you have to stay in the hospital will depend on this treatment plan. You typically will be up and walking in the hospital by the end of the first day after the surgery. You may return to work in 3-6 weeks, depending on how well your body is healing and the type of work/activity level you plan to return to.

Work closely with your spinal surgeon to determine the appropriate recovery protocol for you, and follow his or her instructions to optimize the healing process.

Are There Any Potential Risks Or Complications?

All treatment and outcome results are specific to the individual patient. Results may vary. Complications such as infection, nerve damage, blood clots, blood loss and bowel and bladder problems, along with complications associated with anesthesia, are some of the potential risks of spinal surgery. A potential risk inherent to spinal fusion is failure of the vertebral bone and graft to properly fuse, a condition that may require additional surgery.

Please consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to the anterior cervical discectomy with fusion procedure.

Cervical artificial disc replacement surgery is a joint replacement procedure that involves inserting an artificial disc, such as the PRESTIGE® Cervical Disc, between the vertebrae to replace a natural spinal disc after it has been removed. This prosthetic device is designed to maintain motion in the treated vertebral segment.

What Is Cervical Artificial Disc Surgery?

Cervical artificial disc surgery is a type of joint replacement procedure, or arthroplasty, which involves inserting a cervical artificial disc into the intervertebral space after a natural cervical disc has been removed.

A cervical artificial disc is a prosthetic device designed to maintain motion in the treated vertebral segment. A cervical artificial disc essentially functions like a joint, allowing for flexion, extension, side bending and rotation. The PRESTIGE® Cervical Disc is the first artificial disc to be approved by the U.S. Food and Drug Administration for use in the cervical spine.

Why Do I Need This Procedure?

The intervertebral discs of the cervical spine are very important for the normal mobility and function of your neck. When healthy, they act as “cushions” for the individual bones of the spine, or vertebrae. Each disc is made up of two parts:

• The nucleus pulposus – the soft, gel-like center of the disc.
• The annulus fibrosis – strong, fibrous outer ring that surrounds and supports the nucleus pulposus.

Over time, discs can become dried out, compressed or otherwise damaged, due to age, genetics and everyday wear-and-tear. When this happens, the nucleus pulposus may push through the annulus fibrosis. Disc degeneration also may result in bone spurs, also called osteophytes. If disc or bone material pushes into or impinges on a nearby nerve root and/or the spinal cord, it may result in pain, numbness, weakness, muscle spasms and loss of coordination, both at the site of the damage and elsewhere in the body, since most the nerves for rest of the body (e.g., arms, chest, abdomen and legs) pass from the brain through the neck. Similar symptoms, however, may occur suddenly if the disc nucleus dislodges acutely and causes nerve root compression, a condition referred to as a herniated disc.

When non-surgical therapies fail to provide relief from your symptoms, your doctor may recommend spine surgery. The goal of cervical artificial disc surgery is to remove all or part of a damaged cervical disc (discectomy), relieve pressure on the nerves and/or spinal cord (decompression) and to restore spinal stability and alignment after the disc has been removed.

A spinal fusion with an anterior cervical plate currently is a very good surgical option for many patients, leaving most symptom-free and able to return to their normal activities within a short period of time. Using bone grafts and instrumentation, such as metal plates and screws, this procedure fuses, or creates a bond between, two or more adjacent cervical vertebrae, ideally stabilizing the segment and providing relief.

Cervical artificial disc replacement surgery, also referred to as spinal arthroplasty or just disc replacement, is another potential treatment option for patients with this condition.

Cervical artificial disc replacement surgery may be an appropriate treatment option for you if:

• You have been diagnosed with cervical radiculopathy, myelopathy or both with the presence of disc herniation and/or bone spurs.
• Your symptoms did not improve after conservative treatment measures, such as exercise, pain relievers, physical therapy and/or chiropractic care.
• You require treatment at only one cervical level.
• You are at least 18 years of age with skeletal maturity.
• Are not pregnant or nursing at the time of surgery.

To determine whether cervical artificial disc replacement surgery is the right treatment for you, your physician will perform a physical exam and other diagnostic testing, such as a spinal X-ray; magnetic resonance imaging (MRI), computed tomography (CT) scan, myelogram and/or a bone scan.

It is important that you discuss the potential risks, complications, and benefits of cervical artificial disc replacement surgery with your doctor prior to receiving treatment, and that you rely on your physician's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.

How Is Cervical Artificial Disc Replacement Surgery Performed?

Through a small incision made near the front of your neck (a surgical approach called the anterior approach) your surgeon will:

• Gently pull aside the soft tissues – skin, fat and muscle – as well as the trachea, or windpipe, to access the cervical spine
• Expose the area where disc fragments and/or bone spurs are pressing against the neural structures (nerve roots and/or spinal cord);
• Remove the disc and bone material from around the neural structures to give them more space (discectomy and decompression);
• Insert and secure the artificial disc into the intervertebral space, using specialized instruments;
• Ease the soft tissues of the neck and other structures back into place; and
• Close the incision.

Knowing what to expect during your procedure can help you face your surgery with confidence. Your doctor can give you additional details about the procedure specific to your condition.

How Long Will It Take Me To Recover?

Your surgeon will have a specific post-operative recovery plan to help you return to your normal activity level as soon as possible. Your length of stay in the hospital will depend on your treatment and physical condition. You typically will be up and walking by the end of the first day after the surgery. Your return to work will depend on how well your body is healing and the type of work/activity level you plan to return to.

Work closely with your spinal surgeon to determine the appropriate recovery protocol for you, and follow his or her instructions exactly to optimize your healing process.

Are There Any Potential Risks Or Complications?

As with any spine surgery, surgical treatment with the PRESTIGE® Cervical Disc is not without risk. A variety of complications may occur, either alone or in combination.

Potential risks associated with any surgery include anesthesia complications, blood clots, allergic reactions and adverse effects due to undiagnosed medical problems, such as silent heart disease. Potential complications associated with spine surgery and the PRESTIGE® Cervical Disc may include:

• Allergic reaction to the implant material
• Implants bending, breaking, loosening, or moving
• Instruments bending or breaking
• Wound, local, and/or bodily (systemic) infections
• Neck and/or arm pain
• Difficulty swallowing
• Impairment of or change in speech
• Nerve or spinal cord injury, possibly causing impairment or paralysis
• Numbness or tingling in extremities
• Tear in the protective membrane (dura) covering the spinal cord
• Loss of motion or fusion at the treated cervical level
• Development or progression of disease at other cervical levels
• Bleeding or collection of clotted blood (hematoma)
• Blood clots and blood flow restrictions, possibly resulting in stroke
• Tissue swelling
• Reactions to anesthesia
• Changes in mental status
• Complications of pregnancy, including miscarriage and fetal birth defects
• Inability to resume activities of normal daily living, including sexual activity
• Death

There is also the risk that this surgical procedure will not be effective, and may not relieve or may cause worsening of preoperative symptoms.

In the US clinical study, there were a number of adverse events. Some of the most common were trauma, difficulty swallowing, impairment of speech, and infection. There may be other risks associated with treatment using the PRESTIGE® device. Although many of the major risks are listed on this website, a more comprehensive list is provided in the physician’s package insert for the product. Please consult your doctor for more information and an explanation of these risks.

Prior to treatment, please discuss the risks associated with cervical artificial disc surgery thoroughly with your doctor.

It is important that you discuss the potential risks, complications and benefits of the PRESTIGE® Cervical Disc with your doctor prior to receiving treatment, and that you rely on your doctor’s judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.

Cervical foraminotomy is a surgical procedure done to relieve the symptoms of a pinched nerve by enlarging the neural foramen, and it can be performed in a minimally invasive way.

The neural foramen is an opening where nerve roots exit the spine and travel throughout the body. It creates a protective passageway for nerves that carry signals between the spinal cord and the rest of the body. A cervical foraminotomy is a surgical procedure that is done to enlarge that passageway.

Traditional, open spine surgery involves cutting or stripping the muscles from the spine. Today, a cervical foraminotomy may be performed using a minimally invasive procedure that allows your spine surgeon to separate the fibers of the muscles surrounding the spine rather than cutting and stripping the muscles away from the spine.

Why is it done?

A pinched nerve in the neck can cause neck pain, stiffness, and pain radiating into the shoulder, arm, and hand, as well as numbness, tingling and/or weakness in the arm and hand.

Herniated discs, bone spurs and thickened ligaments or joints can all cause narrowing of the neural foramen and cause painful symptoms. Patients who do not improve with conservative treatment may be candidates for surgery.

How is it done?

The Operation

The operation is performed with the patient on his or her stomach.

Decompression

A small incision is made on the symptomatic side of the neck. Next, the muscles are gradually dilated and a tubular retractor is placed to give the surgeon access to the spine.

Bone or disc material and/or thickened ligaments are then removed to decompress and relieve pressure on the spinal cord and/or nerves.

The tubular retractor is removed, allowing the dilated muscles to come back together.

Closure

The incision is closed, and in most instances results in only a small scar.

After Surgery

This minimally invasive procedure typically allows many patients to be discharged the same day of surgery; however, some patients will require a longer hospital stay. Most patients will notice immediate improvement of some or all of their symptoms; however, other symptoms may improve more gradually.

A positive attitude, reasonable expectations and compliance with your doctor's post-surgery instructions all may contribute to a satisfactory outcome. Many patients are able to return to their regular activities within several weeks.

It is important that you discuss the potential risks, complications, and benefits of spinal surgery with your doctor prior to receiving treatment, and that you rely on your physician's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.

An anterior cervical corpectomy and fusion is a surgical procedure in which vertebral bone and intervertebral disc material is removed to relieve pressure on the spinal cord and spinal nerves (decompression) in the cervical spine, or neck.

What Is An Anterior Cervical Corpectomy And Fusion?

The term corpectomy is derived from the Latin words corpus (body) and -ectomy (removal). The procedure typically involves accessing the cervical spine through an anterior approach, or from the front. Spinal fusion is usually necessary because of the amount of vertebral bone and/or disc material that must be removed to achieve sufficient decompression of the neural structures.

Spinal fusion involves placing bone graft or bone graft substitute between two or more affected vertebrae to promote bone growth between the vertebral bodies. The graft material acts as a binding medium and also helps maintain normal disc height - as the body heals, the vertebral bone and bone graft eventually grow together to join the vertebrae and stabilize the spine.

Why Do I Need This Procedure?

Nerve compression in the cervical can cause neck pain and/or pain, numbness and weakness that extends into the shoulders, arms and hands.

Degenerative spinal conditions, including herniated discs and bone spurs, are common causes of spinal nerve compression. Spinal fracture, tumor or infection also may result in pressure on the spinal nerves.

To determine whether your condition requires treatment with an anterior cervical corpectomy and fusion, your doctor will examine your spine and take your medical history, and may order an x-ray, computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of your cervical vertebrae. An anterior cervical corpectomy and fusion is typically recommended only after conservative treatment methods fail. Your surgeon will take a number of factors into consideration before making this recommendation, including the condition to be treated, your age, health and lifestyle and your anticipated level of activity following surgery. Please discuss this treatment option thoroughly with your spinal care provider.

How Is A Cervical Corpectomy Performed?

Through an incision either to the right or left of the midline of your neck, your surgeon will:

• Gently retract the muscles and tissues of the neck to expose the anterior vertebral column.
• Remove a portion of the vertebral body(ies) and intervertebral disc(s) to access the compressed neural structures
• Relieve the pressure by removing the source of the compression
• Place a bone graft or bone graft substitute between the adjacent vertebrae at the decompression site
• Attach instrumentation, such as plating and screws, along the treated vertebra(e) to provide extra support and stability while fusion and healing occurs.

How Long Will It Take Me To Recover?

Your surgeon will have a specific postoperative recovery plan to help you return to your normal activity level as soon as possible. Following an anterior cervical corpectomy and fusion, you may notice an immediate improvement of some or all of your symptoms; other symptoms may improve more gradually. The amount of time that you have to stay in the hospital will depend on your treatment plan. How quickly you return to work and your normal activities will depend on how well your body heals and the type of work/activity level you plan to return to.

Work closely with your spinal surgeon to determine the appropriate recovery protocol for you, and follow his or her instructions to optimize the healing process.

To determine whether you are a candidate for an anterior cervical corpectomy and fusion, please talk to your doctor.

Are There Any Potential Risks Or Complications?

All treatment and outcome results are specific to the individual patient. Results may vary. Complications such as infection, nerve damage, blood clots, and blood loss, along with complications associated with anesthesia, are some of the potential risks of spinal surgery. A potential risk inherent to spinal fusion is failure of the vertebral bone and graft to properly fuse, a condition that may require additional surgery.

Please consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to the anterior cervical corpectomy and fusion procedure.

A cervical laminoplasty is a spine surgery that involves reshaping/repositioning bone to relieve excess pressure on the spinal nerve(s) in the cervical spine, or neck. A cervical laminoplasty is often performed to relieve the symptoms of spinal stenosis, the narrowing of the spinal canal.

What Is A Cervical Laminoplasty?

A cervical laminoplasty is a spine surgery that involves reshaping/repositioning bone to relieve excess pressure on the spinal nerve(s) in the cervical spine, or neck. The name of the procedure is derived from the Latin word lamina (thin plate, sheet or layer), and the Greek term plastos (to mold). A laminoplasty differs from a laminectomy in that the lamina is repositioned rather than removed.

Why Do I Need This Procedure?

Spinal stenosis is a condition caused by a gradual narrowing of the spinal canal. This narrowing happens as a result of the degeneration of both the facet joints and the intervertebral discs. The facet joints also enlarge as they become arthritic, which contributes to a decrease in the space available for the nerve roots. Bone spurs, called osteophytes also can form and grow into the spinal canal, and connecting ligaments also may thicken.

These processes narrow the spinal canal and may begin to impinge upon and place pressure on the nerves roots and spinal cord, resulting in such symptoms as:

• Neck pain
• Pain that radiates into the shoulders, arms and/or hands
• Numbness, tingling and muscle weakness in the neck and/or upper extremeties
• Bowel and/or bladder impairment

The goal of a cervical laminoplasty is to relieve pressure on the spinal nerves by removing the source of the pressure while still maintaining the stability of the posterior elements of the vertebrae. The procedure also is referred to as an “open door laminoplasty” because it involves “hinging” one side of the posterior elements of the vertebrae and cutting the other side so that it forms a “door” which is then opened and held in place with wedges made of bone and instrumentation.

To determine whether your condition requires treatment with a cervical laminoplasty, your doctor will examine your back and your medical history, and may order an X-ray, computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of your spine. A surgical procedure such as a cervical laminoplasty is typically recommended after non-surgical treatment options, such as medication, rest and physical therapy, fail to relieve symptoms after a reasonable length of time.

How Is A Cervical Laminoplasty Performed?

The operation is performed with the patient on his or her stomach, sedated under general anesthesia.

Through a small incision made at or near the center of the back of the neck, your surgeon will:

• Cut a groove down one side of the cervical vertebra(e), creating a hinge
  Cut through the other side of the vertebra(e)
• Remove the tips of the spinous processes, to create room for the bones to pull open like a door
• Bend the back of each vertebre open like a door on its hinge, removing pressure from the spinal cord/nerves
• Remove any other sources of compression; i.e., bone spurs, disc material or excess ligament
• Place small wedges of bone in the “open” space of the door, and then secure the door in the open position with instrumentation
• Ease the soft tissues back into place and close the incision.

How Long Will It Take Me To Recover?

Your surgeon will have a specific post-operative recovery/exercise plan to help you return to your normal activity level as soon as possible. Following a cervical laminoplasty, you may notice an immediate improvement of some or all of your symptoms; other symptoms may improve more gradually.

The amount of time that you have to stay in the hospital will depend on your treatment plan. In some instances, this procedure may be done on an outpatient basis. You typically will be up and walking in the hospital by the end of the first day after the surgery. Your return to work will depend on how well your body is healing and the type of work/activity level you plan to return to.

Work closely with your spinal surgeon to determine the appropriate recovery protocol for you, and follow his or her instructions “to the letter” to optimize the healing process.

To determine whether you are a candidate for a cervical laminoplasty, please talk to your doctor.

Are There Any Potential Risks Or Complications?

All treatment and outcome results are specific to the individual patient. Results may vary. Complications such as infection, nerve damage, blood clots, blood loss and bowel and bladder problems, along with complications associated with anesthesia, are some of the potential risks of spinal surgery. A potential risk inherent to spinal fusion is failure of the vertebral bone and graft to properly fuse, a condition that may require additional surgery.

Please consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to the cervical laminoplasty procedure.

As you prepare yourself mentally to undergo spinal surgery, you also need to prepare yourself for the recovery period that will follow your operation. While the surgery entails work on the part of the surgeon, after that, the brunt of the work is in your hands. To ensure a smooth and healthy recovery, it is important that, as a patient, you closely follow the set of instructions that your surgical team gives you.

Hospital Recovery

After the operation, you will be brought to the recovery room or intensive care unit (ICU) for observation. When you wake up from the anesthesia, you may be slightly disoriented, and not know where you are. The nurses and doctors around you will tell you where you are, and remind you that you have undergone surgery. As the effects of the anesthesia wear off, you will feel very tired, and, at this point, will be encouraged to rest.

Members of your surgical team may ask you to respond to some simple commands, such as "Wiggle your fingers and toes" and "Take deep breaths." When you awaken, you will be lying on your back, which may seem surprising, if you have had surgery through an incision in the back; however, lying on your back is not harmful to the surgical area.

Prior to the surgery, an intravenous (IV) tube will be inserted into your arm to provide your body with fluids during your hospital stay. The administration of these fluids will make you feel swollen for the first few days after the operation.

When you awake from the anesthesia, you may feel the urge to urinate. So, in addition to the IV, a catheter tube (also commonly called a Foley Catheter) may be placed into your bladder to drain urine from your system. The catheter serves two purposes: (1) it permits the doctors and nurses to monitor how much urine your body is producing, and (2) it eliminates the need for you to get up and go to the bathroom. Once you are able to get up and move around, the catheter will be removed, and you can then use the bathroom normally.

During your hospital stay, you will get additional instructions from your nurses and other members of your surgical teams regarding your diet and activity.

Proper nutrition is an important factor in your recovery. Your surgeon may restrict what you drink and eat, or place you on a special diet, depending on the surgical approach that was used during the operation. Calories and food intake are an important part of recovery. Some patients find that their physician orders are less restrictive than the diet they follow at home. After the surgery, you will continue to receive intravenous fluids until you are able to tolerate regular liquids, which typically involves gradually transitioning you from sips of clear fluids to full liquids (including JELL-O® gelatin). From there, you will be given small amounts of solid food until you are ready to return to a regular diet.

With respect to physical activity, in most cases, your surgeon will want for you to get out of bed on the first or second day after your surgery. Nurses and physical therapists will assist you with this activity until you feel comfortable enough to get up and move around on your own.

Home Recovery

Before you are discharged from the hospital, your doctor and other members of the hospital staff will give you additional self-care instructions for you to follow at home - a list of "dos and don'ts," which you will be asked to follow for the first 6 to 8 weeks of your home recovery. So, if you are unsure of any of these instructions, ask for clarification. Following these instructions is crucial to your recovery.

Nowadays, surgery involves one or more incisions depending on the surgical approach used to perform the operation. Therefore, when you are discharged home you may still have a surgical dressing on your incision(s). Either a nurse will visit your home to change the dressing or a caregiver, such as one of your family members, will be taught to do it for you. It is important that the dressing be changed daily and kept dry.

If any signs of infection are observed while changing the dressing, call your doctor. These signs include:

• Fever - a body temperature greater than 101°F (38°C)
• Drainage from the incision(s)
• Opening of the incision(s), and
• Redness or warmth around the incision(s).

In addition, call your doctor if you experience chills, nausea/vomiting, or suffer any type of trauma (e.g., a fall, automobile accident).

During this recovery period, you will also be instructed to keep your incision(s) clean, making sure only to use soap and water to cleanse the area. In general, you should not shower until your doctor has permitted you to do so.

In addition to caring for your incision(s), you will also be encouraged to:

• Drink plenty of fluids
• Maintain a healthy diet (high in protein)
• Walk or do deep-breathing exercises, and
• Gradually increase your physical activity.

Activities to avoid include any heavy lifting, climbing (including stairs), bending, or twisting. You should also avoid the use of skin lotion in the area of the incision(s); you need to keep this area dry until it has had the opportunity to heal well.

Follow up with your doctor on a regular basis during this post-operative period, and make sure to call your doctor if you have any concerns or questions.