Recovery After Surgery for Cervical Spine Trauma in Children

Postoperative Orders

• Imaging: X-rays or a CT scan are requested 24–38 hours postoperatively to ensure appropriate metalwork placement and alignment.
• Analgesia: Intravenous opiate analgesia is often required in the initial postoperative period. Oral nonsteroidal anti-inflammatory drugs should be used thereafter. Diazepam can be helpful in the management of postoperative pain due to muscle spasm.
• Antibiotics: Prophylactic antibiotics should be given according to local policy. This should not exceed 24 hours; there is no role for extended antibiotic therapy.
• Wound care: Wound dressings should remain clean, dry, and undisturbed unless soiled. The wound should be inspected and dressings changed prior to discharge.
• Wound drains: If a drain has been placed, it should ideally be removed within 24 hours of surgery.
• Physical therapy: Children should be mobilized as soon as pain control permits. Postoperative orthotic support will not be routinely required following adequate internal fixation but may help in early pain control.

Postoperative Morbidity

• Incisional pain: Neck stiffness is common in the early postoperative period but resolves spontaneously in most cases. A hard cervical collar may afford relief during this period.
• Swallow/speech difficulties: These symptoms may complicate anterior cervical procedures, particularly where multiple-level access has been required. Both are usually self limiting.