Post-Surgery Symptoms After Lumbar Decompression

Lumbar decompression surgery

Dear Vice Dean Li,
I have an 82-year-old elder at home who has been experiencing left leg numbness (from the back of the left knee down to the sole of the foot) for over a decade.
Additionally, there is a burning sensation on the dorsum of the foot, making it difficult for them to stand or sit for extended periods, which exacerbates the numbness and heat, severely impacting their quality of life.
Two months ago, we went to the hospital for an MRI, which revealed severe compression at the fourth and fifth lumbar vertebrae (there was no space between the vertebrae).
Consequently, the doctor performed a decompression surgery on the fourth and fifth lumbar vertebrae.
Post-surgery imaging shows that there is now considerable space where the compression was, appearing almost normal, and it has been stabilized with screws.
However, two months have passed, and there has been no improvement in any of the symptoms.
I would like to consult the physician regarding the following: 1.
If there has been no improvement in symptoms post-surgery, could there be other underlying causes? 2.
We reside in New Taipei City; are there any recommended hospitals, physicians, or treatment options available for further care for the elder?
Thank you for your valuable time; I greatly appreciate it!

Ms. Chen, 40~49 year old female. Ask Date: 2017/11/16

Dr. Li Yongheng reply Orthopedics

Hello, your 82-year-old family member underwent lumbar decompression surgery on the fourth and fifth lumbar vertebrae two months ago.
If there has been no improvement in symptoms at all, it is indeed somewhat unusual.
Typically, after decompression surgery, there should be some degree of symptom improvement, even if it is not complete.
Therefore, it may be necessary to evaluate whether there is compression in other vertebrae aside from the fourth and fifth lumbar vertebrae.
It is advisable to discuss this with the original treating physician, and if necessary, to perform another MRI scan (including the cervical, thoracic, and lumbar spine).
Dr.
Ming-Chao Chang or Dr.
Shih-Tien Wang at Taipei Veterans General Hospital are both authorities in spinal surgery, and you might consider consulting them for additional opinions.
Wishing your family member a speedy recovery.

Reply Date: 2017/11/16

More Info

After lumbar decompression surgery, it is not uncommon for patients to experience persistent symptoms, particularly if they had pre-existing conditions like nerve compression. In your case, your elderly relative has been suffering from left leg numbness and burning sensations for many years, which were exacerbated by severe compression at the L4-L5 levels. Although the surgery aimed to alleviate these symptoms by decompressing the affected nerves, the lack of improvement two months post-surgery raises several important considerations.

1. Reasons for Persistent Symptoms:
- Nerve Damage: If the nerves were severely compressed for an extended period before surgery, there might be residual nerve damage that does not resolve immediately after decompression. Nerve healing can take time, and in some cases, the symptoms may persist even after the mechanical compression has been relieved.

- Scar Tissue Formation: Post-surgical scar tissue can develop around the nerves, potentially leading to continued symptoms. This is known as epidural fibrosis and can occur after any spinal surgery.

- Adjacent Segment Disease: The surgery may alter the biomechanics of the spine, leading to increased stress on adjacent segments, which could cause new or worsening symptoms.

- Underlying Conditions: Other underlying conditions, such as peripheral neuropathy, vascular issues, or other spinal pathologies, could also contribute to the ongoing symptoms.

2. Next Steps for Treatment:
- Follow-Up with a Specialist: It is crucial to follow up with the surgeon who performed the decompression to discuss the lack of improvement. They may recommend imaging studies, such as an MRI or CT scan, to assess for any complications or changes in the spine post-surgery.

- Physical Therapy: Engaging in a structured physical therapy program can help improve mobility and strengthen the muscles around the spine, which may alleviate some symptoms. A physical therapist can also provide modalities to manage pain and improve function.

- Pain Management: If the symptoms are significantly affecting quality of life, a pain management specialist may be able to offer interventions such as nerve blocks, medications, or other therapies to help manage pain and discomfort.

- Alternative Therapies: Consider exploring complementary therapies such as acupuncture, chiropractic care, or massage therapy, which may provide relief for some patients.

- Second Opinion: If the current treatment plan does not yield results, seeking a second opinion from another spine specialist or neurologist may provide new insights or treatment options.

3. Recommended Facilities:
- In New Taipei City, there are several reputable hospitals and specialists who focus on spinal disorders. Institutions like Taipei Medical University Hospital or National Taiwan University Hospital have departments specializing in neurosurgery and orthopedics. It may be beneficial to consult with a specialist who has experience in treating elderly patients with complex spinal issues.

In conclusion, while it can be disheartening to see no improvement after surgery, there are multiple avenues to explore for further evaluation and treatment. Engaging with healthcare professionals who can provide a comprehensive approach to your relative's symptoms is essential for improving their quality of life.

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