Post-Surgery Pain After Lumbar Spondylolisthesis: Causes and Solutions

Q: Post-Surgery Pain After Lumbar Spondylolisthesis: Causes and Solutions

Hello： Since this is not my surgical patient and there are no images available, I cannot provide a definitive response. <br>However, since you have concerns and are unable to improve with the original physician, I recommend that you personally seek a consultation with another exp

Postoperative pain after lumbar spondylolisthesis surgery?

Hello Dr.
Lai, I have been experiencing numbness in both legs after standing for a long time or walking for about 5 minutes (without pain), followed by weakness and loss of control over my movements.
After an MRI diagnosis by a neurosurgeon, it was determined that I have severe lumbar spondylolisthesis at L3/L4/L5, which is significantly compressing the nerves.
Earlier this year, I decided to undergo surgery for the spondylolisthesis, during which 6 screws were placed and two artificial bone grafts (interbody fusion devices) were inserted at L3/L4/L5.
Post-surgery, the numbness in my legs has improved, but about a month after the surgery, when I lie flat and try to "roll to the side," "lift my legs up," or "get out of bed," I experience abnormal pain in my right leg (not in the left leg) that radiates from my right hip (hip joint) along the outer thigh to the knee, especially at the right hip.
However, this pain is not very noticeable when walking; only the right hip has a slight dull ache.
The doctor prescribed pain medication and advised me to rest, but the pain persists with little improvement.
This pain was not present before the surgery and is affecting my daily activities, particularly getting in and out of bed.
Dr.
Lai, what could be the cause of this pain? Is it possible that a nerve is being compressed? Do you have any suggestions for improvement? Can I seek a second opinion from another physician at a different hospital? I am feeling anxious and fearful that this pain will be permanent after the surgery.
I hope you can help clarify my concerns.
Thank you very much!

Ellis Lin, 40~49 year old female. Ask Date: 2018/02/20

Dr. Lai Zhaokang reply Neurosurgery

Hello: Since this is not my surgical patient and there are no images available, I cannot provide a definitive response.
However, since you have concerns and are unable to improve with the original physician, I recommend that you personally seek a consultation with another expert in neurosurgery or spinal surgery.
I wish you the best with Dr.
Lai Chao-Kang, the Director of the Spine Neurosurgery Department at Changhua Hospital.

Reply Date: 2018/02/20

More Info

Post-surgery pain after lumbar spondylolisthesis can be a complex issue, often stemming from a variety of causes. In your case, it seems that you underwent surgery to address significant nerve compression due to spondylolisthesis at the L3-L4-L5 levels. While it is encouraging that you experienced some improvement in your symptoms post-surgery, the persistence of pain, particularly in your right hip and thigh, raises several considerations.

Possible Causes of Post-Surgery Pain
1. Nerve Irritation or Compression: After surgery, it is possible that the nerves in the lumbar region may still be irritated or compressed. This can happen due to scar tissue formation or inflammation around the surgical site. The pain you describe, radiating from the hip down the thigh, could indicate that the sciatic nerve or other nerve roots are still being affected.

2. Muscle Strain: The surgical procedure itself can lead to muscle strain or weakness, particularly if certain muscles were manipulated or if you have been compensating for pain pre-surgery. This can result in pain during movements such as turning or lifting your legs.

3. Postoperative Complications: Although less common, complications such as hematoma (a localized collection of blood outside of blood vessels) or infection can also contribute to ongoing pain.
4. Failed Back Surgery Syndrome (FBSS): This term refers to a condition where patients continue to experience pain after spinal surgery. It can be due to various factors, including inadequate decompression, new disc herniation, or other spinal issues that were not addressed during the initial surgery.

Recommendations for Management
1. Follow-Up with Your Surgeon: It is crucial to maintain open communication with your orthopedic or neurosurgeon. They can evaluate your symptoms and may recommend imaging studies, such as an MRI, to assess for any complications or changes since your surgery.

2. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can help you strengthen the muscles around your spine, improve flexibility, and teach you proper body mechanics to reduce strain during daily activities.

3. Pain Management: If over-the-counter pain medications are not effective, your doctor may prescribe stronger pain relief options or recommend nerve pain medications such as gabapentin or pregabalin, which can help with nerve-related pain.

4. Alternative Therapies: Consider exploring alternative therapies such as acupuncture, chiropractic care, or massage therapy, which some patients find helpful in managing chronic pain.

5. Seek a Second Opinion: If your current treatment plan is not yielding results, it may be worthwhile to seek a second opinion from another spine specialist. They can provide a fresh perspective on your condition and treatment options.

6. Psychological Support: Chronic pain can take a toll on mental health. Consider speaking with a psychologist or counselor who specializes in chronic pain management to help you cope with the emotional aspects of your recovery.

Conclusion
While it is understandable to feel anxious about ongoing pain after surgery, it is essential to approach the situation systematically. By working closely with your healthcare team, you can explore various avenues for relief and improve your quality of life. Remember, recovery from spinal surgery can take time, and patience is often required as you navigate this journey.

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