Post-Surgery Concerns After Lumbar Spine Surgery: Pain and Next Steps - Orthopedics

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Postoperative issues following bone grafting surgery?


Hello Dr.
Lee: My father just underwent a spinal fusion surgery at the beginning of March and was discharged on March 3rd.
He had his stitches removed on March 9th, and since then, on March 14th, he has been reporting increased pain and numbness in the surgical area, particularly from the lumbar spine down to the left leg.
The pain seems to be worsening.
What could be the reason for this? During the treatment period, he had an MRI scan, which showed a dark area in one part of the bone, but it was unclear what condition it indicated.
Therefore, on the day of the stitch removal follow-up, the doctor recommended that we go to a medical center for a PET scan at our own expense, which we have already scheduled for next week.
However, I am really worried.
Is this situation very concerning? Is the increasing pain related to this finding, or could it be a surgical issue? This is my first time asking a question online, and I truly care about my family! Thank you very much for your response, Dr.
Lee!

Wa'er, 40~49 year old female. Ask Date: 2018/03/14

Dr. Li Yongheng reply Orthopedics


Hello, you are truly a devoted daughter.
Your father has recently reported an increase in pain and discomfort in the lumbar region and left leg compared to when he was first discharged from the hospital.
The pain seems to be worsening, which may be related to the bone cement or the fracture itself compressing the nerves.
If the increasing pain does not improve, I recommend an MRI post-surgery to assess for any nerve compression issues.
Wishing your father a speedy recovery.

Reply Date: 2018/03/14

More Info


Post-surgery concerns after lumbar spine surgery, such as increased pain and discomfort, can be distressing for both patients and their families. Based on your father's recent experience following his lumbar spine surgery, it is essential to understand the potential reasons for the increased pain and the appropriate next steps for management.

Firstly, it is not uncommon for patients to experience fluctuations in pain levels after spinal surgery. This can be attributed to several factors, including inflammation, nerve irritation, or even the healing process itself. After surgery, the body undergoes a significant amount of healing, which can sometimes lead to increased discomfort as the tissues repair and adjust. However, if the pain is progressively worsening, it may indicate a complication that needs to be addressed.

The MRI report you mentioned, which indicated a "black spot" on the bone, raises some concerns. This could represent several conditions, including a hematoma (a localized collection of blood outside of blood vessels), infection, or even a potential issue with the surgical site, such as a non-union of the vertebrae or a recurrent disc herniation. The fact that your father is experiencing increased pain radiating down his left leg could suggest nerve involvement, possibly due to inflammation or compression.

Given these symptoms, it is prudent to follow the advice of the medical team and proceed with the recommended PET scan. This imaging study can provide more detailed information about metabolic activity in the area of concern, helping to differentiate between benign and potentially more serious issues. It is essential to communicate openly with the healthcare providers about any new or worsening symptoms, as they can guide the next steps in management.

In terms of treatment, if the imaging studies reveal a complication, the treatment plan may vary significantly based on the findings. Options could include conservative management, such as physical therapy and pain management, or more invasive interventions, such as additional surgery if necessary. If there is evidence of nerve compression, surgical intervention might be warranted to relieve the pressure and prevent further neurological deficits.

It is also important to consider the role of rehabilitation in recovery. Engaging in a structured physical therapy program can help strengthen the muscles around the spine, improve flexibility, and promote healing. However, this should be approached cautiously, especially if there are concerns about nerve involvement or other complications.

In summary, while increased pain post-surgery can be concerning, it is crucial to await the results of the upcoming imaging studies to determine the underlying cause. Maintaining open communication with the healthcare team and following their recommendations will be vital in managing your father's recovery. If complications are identified, a tailored treatment plan can be developed to address the specific issues at hand. Your concern for your father's well-being is commendable, and with appropriate medical guidance, there is hope for improvement in his condition.

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