@sksdl Hello and welcome to Connect. I am a Mayo spine surgery patient and had an ACDF 5 years ago for one level C5/C6. It took about 3 months to heal and for the fusion to begin, and after that I went through physical therapy for several months. I was in a neck brace for 3 months because by doing that, I could avoid having hardware placed on my spine, and just had a donor bone spacer. I did have spinal cord compression from a disc osteophyte complex that was pressing into my spinal cord. The frontal approach ACDF was not that bad. I found I could tolerate the after surgery pain without drugs, and since the pain meds nauseated me, that was an easy choice. I was tired a lot and slept a lot which is normal for healing from a big surgery. The posterior approach to cervical surgery hurts more because of going through the muscles that you are using to hold your head upright. The interesting thing is that as soon as the spinal cord and any nerves were decompressed, I felt better immediately and all the related pain was gone. What was left is the pain of healing the incision.

I can tell you that in my experience, the pain of surgery for a fractured ankle was much greater and for a longer period of time than anterior cervical spine surgery. I broke my ankle last year and had a few surgeries, and the last a month ago was to remove the hardware that was bothering me. My body reacts to metals, and that is why I chose spine surgery without hardware. That isn't always a choice, but it is worth asking about hardware and the problems that can come from it.

I would expect posterior surgery to cause muscle pain when you move your neck, that is when you are allowed to move your neck again. It is a long recovery, and you will have restrictions on lifting with your arms. Mine started at a ten pound limit. What does help when you are in the rehab stage is physical therapy with a PT who also does myofascial release. MFR can help loosen the scar tissue that gets tight and it helped me have a great recovery in doing this before and after surgery. C2 to T2 is going to make a long tight scar. Here is our MFR discussion with lots of links to information in the first pages. There is also a provider search at http://mfrtherapists.com/
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

Does your surgeon have any patients who would be willing to talk to you who have had this combined procedure? I was also wondering how they will decompress the posterior longitudinal ligament. Does this involve cutting the vertebrae to shift it to allow more room inside the canal, and does this use a hardware connection to hold it in a new position? With a big involved surgery, it is a good idea to get several opinions as there may be different ways to solve the problem with different procedures. You need to choose what is best for you if the opinions are different. Your surgeon should explain the benefits and risks and how that relates to you personally.

How did your surgeon describe the procedure?