Post-Surgery Complications of Lumbar Spondylolisthesis: What to Expect

Postoperative complications of spinal spondylolisthesis surgery?

Hello Dr.
Chang, on February 24, I underwent surgery for a herniated disc and spondylolisthesis from the fourth lumbar vertebra to the fourth sacral vertebra.
During the procedure, three resin interbody fusion devices were implanted.
Upon waking up from surgery, I noticed significant numbness in my right ankle and the back of my calf.
The doctor mentioned that the nerves need time to heal, but the original numbness in my ankle has not improved.
Starting April 20, the numbness in my ankle has become accompanied by pain and discomfort, and within a week, it has extended to my hip joint, causing tightness and stiffness that makes it difficult to stand.
Although there are no unusual signs at the surgical site on my back, I occasionally experience pain there.
After removing the abdominal binder, my entire back feels heavy and unstable.
For the past four days, I have been waking up in the morning due to pain in my pelvic bones.
I returned to the hospital for a follow-up, and they prescribed pain medication and advised me to rest more.
What should I do? Have I injured my nerves? Thank you!

Xiao Cui, 40~49 year old female. Ask Date: 2016/05/11

Dr. Zhang Junwei reply Neurosurgery

It is evident that your postoperative pain is more severe than it was before the surgery, which theoretically should not happen.
There may have been some issues during the surgical procedure.
It is advisable to discuss this further with your attending physician or consider undergoing an MRI examination.

Reply Date: 2016/05/11

More Info

Post-surgery complications following lumbar spondylolisthesis surgery can be quite concerning, especially when symptoms such as numbness, pain, and stiffness arise. Based on your description, it seems that you are experiencing a range of symptoms that may indicate nerve involvement or complications related to the surgical procedure.

Firstly, it's important to understand that after lumbar spine surgery, especially involving procedures like spinal fusion or disc replacement, patients can experience a variety of postoperative symptoms. These may include pain, numbness, tingling, and weakness in the legs, which can be attributed to nerve irritation or damage during the surgery. In your case, the numbness and pain in your right ankle and calf, which have now extended to your hip, could suggest that the nerve root is being compressed or irritated.

The timeline of your symptoms is also significant. You mentioned that the numbness and pain began shortly after surgery and have progressively worsened. This could indicate that the nerve is not healing as expected or that there may be other complications, such as scar tissue formation or a hematoma (a localized collection of blood outside of blood vessels) that could be pressing on the nerve.

Regarding the "repair period" mentioned by your doctor, it's true that nerves can take time to heal after being compressed or irritated. However, if symptoms persist or worsen, further evaluation is warranted. This may include imaging studies such as an MRI or CT scan to assess for any structural issues that could be contributing to your symptoms, such as herniated discs, spinal stenosis, or other complications.

In terms of management, here are some steps you can consider:
1. Follow-Up with Your Surgeon: It's crucial to maintain open communication with your surgeon. If your symptoms are not improving or are worsening, you should express your concerns and possibly request further imaging or a referral to a neurologist or pain specialist.

2. Physical Therapy: Engaging in a structured physical therapy program can help improve mobility, strengthen the surrounding muscles, and alleviate some of the discomfort. A physical therapist can provide exercises tailored to your condition and help you regain function.

3. Pain Management: If you are experiencing significant pain, discuss with your doctor about adjusting your pain management regimen. This may include medications, nerve blocks, or other interventions.

4. Activity Modification: Pay attention to your body and avoid activities that exacerbate your symptoms. Gradually increase your activity level as tolerated, but ensure you are not overexerting yourself.

5. Monitor Symptoms: Keep a detailed record of your symptoms, including when they occur, their intensity, and any activities that seem to trigger or alleviate them. This information can be valuable for your healthcare provider in determining the best course of action.

6. Consider a Second Opinion: If you feel that your concerns are not being adequately addressed, seeking a second opinion from another spine specialist may provide additional insights or treatment options.

In conclusion, while some postoperative symptoms can be expected, the persistence and worsening of your symptoms warrant further investigation. It is essential to work closely with your healthcare team to ensure that any potential complications are addressed promptly and effectively. Your recovery is a priority, and understanding the underlying causes of your symptoms will be key to achieving a better outcome.

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