After Neck Surgery

The big picture

Most neck operations are done through the front, through a small incision in a skin crease, with the throat and the food pipe gently moved aside. That is why a sore throat, a hoarse voice, and some trouble swallowing are the most common complaints in the first week or two, and why they fade. If your surgery was done from the back, the muscles at the back of the neck will be sore instead. Arm pain from a pinched nerve is usually much better right away; numbness and weakness take longer.

The first week

• Swallowing: start with liquids and soft foods, and move to a regular diet as swallowing allows. Ice chips and cold drinks calm the throat. Small bites, chewed well. Some phlegm and throat clearing is normal; a lozenge or throat spray helps. If swallowing gets steadily worse instead of better, or you cannot swallow even sips of water, call us the same day.
• Sleep with your head raised about 30 degrees on pillows or in a recliner for the first 7 to 10 days. It reduces swelling in the neck. Then lower the pillows gradually.
• Walk several times a day. Walking helps a fusion heal by increasing blood flow, and it keeps your lungs clear.
• Keep the incision dry for two days. Then you may shower; let water run over it, do not rub, and pat dry. Leave the paper strips or glue until they fall off. No ointments. No baths, pools, or soaking for six weeks.
• Send a photo of the incision to the office at 2 weeks.

The collar

After a disc replacement or a one-level fusion, many patients need no collar, or only a soft collar for comfort in the first week or two. After a longer fusion or surgery from the back, a collar may be worn for several weeks. Your discharge paperwork says which applies to you.

• If you were given a collar: wear it when up and about and in the car. You may remove it to shower, shave, and eat, and for short rests while sitting still. Do not bend your chin to your chest or tip your head far back while it is off.
• Skin under the collar: keep it clean and dry; a thin cotton liner or a tube sock cut open prevents rubbing. Wash soft collars in cold water and air dry; hard-collar pads wash with soap and water.

Pain and medicine

• Acetaminophen (Tylenol) on a schedule, up to 3,000 mg a day unless told otherwise.
• Opioids for the first days, tapered steadily. Do not drive while taking them.
• A muscle relaxant for neck and shoulder-blade spasm, if prescribed.
• No anti-inflammatories (ibuprofen, naproxen, meloxicam, celecoxib) after a fusion for at least three months; they slow bone healing. After a disc replacement alone, I will tell you when they are allowed.
• A short steroid pack may be prescribed to use only if swallowing or swelling gets worse. Call before starting it.
• Constipation: stool softener from day one while on opioids, fluids, and walking; add a gentle laxative by day three if needed.
• Pain between the shoulder blades, and a flare of neck pain around week two to three, are common while a fusion is forming and settle on their own.

Activity and restrictions

For six weeks: no lifting more than 10 pounds, no overhead work, no pushing or pulling with the arms, and no sports. You may raise your arms to wash your hair.

• Driving: when you are off opioids and can turn your head enough to check your mirrors, usually two to four weeks after a disc replacement or one-level fusion, and after the collar comes off for longer fusions. Wear your collar as a passenger if one was prescribed.
• Desk work: often one to three weeks. Physical work: usually six weeks or more.
• Exercise: walking from day one. Light stationary bike at about three weeks. Physical therapy for posture and the deep neck muscles usually begins at the six-week visit. Running and gym work after that visit.

What recovery feels like over months

• Swallowing can take a few months to feel completely normal, and the firmness beside the throat softens over three to four months.
• A fusion takes 4 to 12 months to become solid. Many patients describe a day, months after surgery, when the ache simply stops. That is the bone finishing its work.
• Arm weakness that was present before surgery can take up to six months to recover. Numbness that lasted more than a few weeks before surgery recovers slowly, and some may be permanent; we judge it at the one-year mark.

Your follow-up

• 2 weeks: incision photo, or a wound check if needed.
• 6 weeks: visit with X-rays if you have a fusion or an implant.
• 3 to 4 months, 1 year, 2 years: X-rays to confirm the fusion and watch the neighboring levels.

Call the office the same day for

• Swallowing that is getting worse, or inability to swallow liquids.
• Spreading redness, drainage, or opening of the incision. Fever over 101.5°F.
• A new or worsening hoarse voice after the first two weeks.
• Arm pain or numbness that is getting worse rather than better.
• Calf pain or a swollen leg.

Call 911 or go to an emergency room for

• Swelling in the neck that makes it hard to breathe, or a muffled voice with trouble breathing. This is rare but is an emergency.
• New weakness in the arms or legs, clumsiness in the hands, or trouble walking.
• Loss of bladder or bowel control.
• Chest pain or sudden shortness of breath.

Learn more

OrthoInfo, Cervical Radiculopathy, Surgical Treatment: orthoinfo.aaos.org (opens in a new tab)

My guide to spine emergency warning signs lists the symptoms that should never wait.

This playbook is general guidance for Dr. Wey's patients. Your own discharge instructions come first. If anything here does not match what you were told, what you were told wins: please ask us.