ACDF scheduled for Wed: How did you manage sleeping post-op?

@birdman518 Hey, Mitch, I'm glad you will soon be moving forward with your recovery. I had a hard collar after my ACDF, and I am a side sleeper. I didn't have a recliner and I was fine in my bed. Make sure to have lots of pillows so you can arrange them to get enough support to be comfortable. If I was uncomfortable, I woke up and changed position. I did sometimes lay on my back with pillows under my knees. You might be more comfortable in a soft collar than I was in my hard one. I chose to stay overnight in the hospital after surgery because I was nauseated and worried about my balance, and just too tired to want to move. It didn't add cost because the insurance clearance allowed for a one night stay. I didn't sleep that well the first night anyway and that would have been the same at the hotel, although the hotel had a recliner. What did help a lot was putting elastic laces in my gym shoes. You won't be able to bend over to tie shoes. It's been 5 years and I still have them and it is so easy to slip on my shoes.

Thanks for the update. Hopefully other members will chime in with some more suggestions for you. How does it feel to be ready to go forward with surgery?

I am ready but still a little nervous. While there are a few people who say "when I woke up my pain was gone", there are seemingly many more who state that their pain continued. I am worried a little that I need to have 3 segments done at once. I know it's true, but it is a bigger deal than only 1 or 2.
On the positive side, I certainly do not want to lose more functionality, as remember I have both radiculopathy as well as myelopathy.. The latter affects my balance and ability to walk.
I will of course "check in" after a bit to report on my status.
Thanks again!
Mitch

@birdman518 Mitch, I will be thinking of you tomorrow. It's OK to be nervous. You are going to have pain from your incision. The pain that has been caused by nerve compression or spinal cord compression might be gone when you wake up. That was my experience. You will have a long recovery and will be tired a lot. Just sleep and eat healthy food to help your body heal. With 3 segments being fused, you will notice your range of motion will be different, but you will get used to it. I was allowed to start physical therapy at about 3 moths post op because that is when the fusion process had begun. That will be something for you to look forward to. The first 2 weeks, I was in the most pain and my throat hurt because it was retracted out of the way during the procedure to get to the spine behind it. It takes about 6 weeks for the incision to heal, and by 6 weeks, most of my surgical pain had subsided, but I was still aware of having had surgery. By 3 months, I was starting to forget I had surgery, but I was weaning out of the neck brace and because my neck was weak, it was exhausting. You may not have that issue if you have some hardware or a plate. I had no hardware by my own choice. I will be looking forward to your updates. Every patient is different, so don't worry about others who have more pain. When you are healed enough, doing myofascial release with a physical therapist can help the tightness that comes with surgical scar tissue. Do what you can to relax tonight, maybe listen to some comforting music. You've got this, and I'm sure you are well prepared for your healing journey.

Thank you, Jennifer. I will be leaving in about 25 minutes. I am grateful to have my wife of almost 40 years to look after me! I do appreciate the time and effort you put into this forum.

Here is my report. My surgery (C3-C6 ACDF) was finished around 11:30am Wed. Not only did I not feel better right away, everything I went in for is exactly the same. But now I have C5 palsy and cannot lift my right arm above my waist. I am pretty bummed out. They kept me in the hospital Wed. night to give me extra shots of steroids (I believe 4 in all), and I got home yesterday around noon.
I don't have much new pain and am glad for that.
They are supposed to try to get me some PT soon for the palsy, although from what I have read it can go away on its own...but it can take many months even if it does.
I really want to try and keep a positive mental attitude for the healing but right now I am much worse off than I was on Tuesday.
If anyone has experience nerve palsy after ACDF I would love to hear your experiences.
Mitch

@birdman518 Hi Mitch. From your description of receiving steroid shots, it sounds like you had a lot of inflammation going on that your surgeon was concerned about. Did they give you any idea of when that may resolve? I am hopeful that the palsy could improve after the inflammation subsides. Inflammation can put pressure on nerves. I certainly experienced a lot of that after I fractured my ankle and was in a cast that would not expand with my foot swelling inside it. I was miserable for awhile, and had to wait it out until the cast came off. Are you able to use some ice packs on your neck to reduce swelling?

Nerves also can take a long time to heal. I had experienced a bad reaction after a spine epidural injection that caused immediate intense burning stabbing pains in my hand. I was also given steroids, but they didn't do anything for me. If I moved, it increased the frequency of the stabbing pains, so the nurse advised me to just get in bed and support my arm on pillows and try not to move. This was the most pain I had ever been in and to this day that is still true. (Spine surgery pain did not even come close to that epidural pain.) It was bad enough that I was shaking uncontrollably and just about convulsing and was well on my way to passing out. That is when I started doing some of my coping strategies to talk myself out of reacting to it. I did deep breathing and played some music in my head. The stabbing pains went on for about 6 weeks and gradually got farther apart. They were most intense in the first 2 weeks.

After I got better, I still had sensitive nerves. Every time, I washed my hands, my right hand was very sensitive to temperature and cold water was painful. That lasted about a year and a half, and then everything returned to normal. You may be having a similar, but more intense reaction. With my ankle healing after the surgeries for the fracture, I was getting zaps of nerve pain for 4 or 5 months which is something that happens as nerves heal.

Hang in there and just rest and sleep. You could ask your surgeon if the inflammation could be causing the palsy and if physical therapy at this stage of inflammation could just make this worse. Inflammation is also part of healing which is why surgeons tell you not to use anti-inflammatories after spinal fusions to promote good bone healing. After my cervical surgery, I had to wait 3 months to start physical therapy that involved my neck, but my surgeon did let me do some work at around 8 weeks because I was having breathing issues that were somewhat related to having thoracic outlet syndrome. The spine surgery made the TOS worse when everything tightened up and got noticeably worse at 6 weeks because of the fascial tightness and surgical scar tissue in close proximity to the areas in my neck and chest that compress nerves to my arms.

It was about the 2nd day after my spine surgery, that my pain got worse which is normal because of inflammation kicking in, and that is where you are now. If you have questions about your situation, don't hesitate to reach out to your surgical team. It takes a lot of patience to get through all this and I'm glad you are trying to stay positive. That will help keep your pain lower. Stress will just increase pain. Remember to breathe and relax as much as you can and tell yourself this is temporary and you are on a healing journey. It will get better a little bit each day. Also do remember to look at the incision area as best you can for any signs of infection. If it doesn't look right, make sure to contact your surgeon. Infections can also increase the level of pain.

Are you able to get comfortable and get some good sleep?

Thanks for reading and replying... lots of good advice. I am sure you are right about the inflammation! But my pain is way above what I went in for, and in places (left arm) that I did not have much before. If the palsy resolves itself, I would be worse off. But I know it can take a long time and do not want to be negative. I will check in when I have a status update.

@birdman518 Mitch, I was thinking about you and had another thought. I have had issues with inflammation after getting injections. There was the spine epidural that I described, but also in the past a diagnostic MRI with a gadolinium injection into my shoulder capsule that caused the joint to swell so I couldn't move it resulting in a frozen shoulder, an inflamed shoulder joint from a flu shot years ago where I couldn't raise my arm all the way up (I later found out about an egg allergy and eggs are used in the flu vax), and when I got my first Covid vaccination (Pfizer), I had some pains in my neck and jaw and a slight pain started in my tongue right after the injection. They sent me to the emergency room. That was likely an allergic reaction to the polyethylene glycol or "PEG" that is a binder in the vaccine. Perhaps this is also used in other things like a steroid injection for the spine? In the emergency room after the Covid vax, I was given an IV with antihistamines and steroids and it stopped the reaction within about 15 minutes. That seems to confirm an allergic reaction. I also felt no symptoms the next day. I presume the effects wore off because on the next two days I had a return of the queasy headache and allergy like symptoms.

What I was wondering is if you may have had an allergic reaction to a component in the steroid injections that they gave you after your surgery (which would then increase inflammation) in addition to the inflammation from the surgery itself? Your surgeon would have ordered the steroid from the hospital pharmacist and there would be a record of the manufacturer. You might be able to find out the ingredients. I have an environmental allergy doctor who advised me to use my asthma inhalers, take antihistamines, and 3000 mg of vitamin C before getting another Covid vaccination (which I did). I had also switched to the J & J vaccine because it does not have PEG. It has Polysorbate 80 (which is a food additive) instead. I still got some asthma from that since it is a somewhat related compound, but it was manageable. I was able to resolve the issues with antihistamines and vitamin C and did not get any neck, throat or tongue pain.

Sometimes something that is supposed to help just causes things to get worse. Do you think your steroid shots made your pain worse? Is this something you would want to discuss with your surgical team as a possible allergic type reaction?

Jennifer

Interesting thoughts. The steroids were the reason they kept me in overnight, as I believe they are supposed to attack inflammation.
I think it is likely I underestimated the scope and nature of this surgery, truth be told.
I have been using ice, which seems to help. It is only been since Wed. AM.
If things really do not improve I will ask my surgeon about allergic reactions. I have not taken any Covid shots, but of course have heard many stories of side effects from them.

Mitch ; I have had ACDF C3-C6 and PCDF C2-T2 in 2019. I did not have the problems that you are describing , but I did want to add this . You just had surgery and there is a lot of irritation and inflammation going on from the manipulation of the structures in your neck . Don’t judge this situation too quickly . Try to just do your best every day and don’t get discouraged . It sounds like maybe you need to have another talk with your surgeon about this and express your disappointment in this unforeseen complication and he may be able to help you work through this . Give yourself some time ! Just because you are having problems now , does not mean it will be that way forever . Usually it takes about six weeks for patients to really feel better after surgery - it has always seemed to be a milestone in healing in my opinion.
Keep us posted . I might be having another surgery at Mayo after my appt toward the end of February . Take care and good luck !