Managing Post-Surgery Complications After Cervical Disc Replacement

Cervical spine surgery sequelae?

Hello Doctor, I have a herniated disc at the C5-C6 level, which has caused severe pain and numbness radiating from my left shoulder, back, arm, and fingers.
After undergoing artificial disc replacement surgery, the symptoms on the left side were immediately relieved.
However, I am unable to lie flat on my back post-surgery; lying flat for just 30 seconds causes sharp pain at the junction of my cervical and thoracic spine, along with muscle spasms in my right scapula and soreness in my right arm.
As a result, I have been unable to sleep for five consecutive days after the surgery and can only doze off while sitting.
The doctor mentioned that this is a normal reaction and I have been on morphine for pain relief for five days, eventually switching to steroids, but the symptoms have not improved.
However, the doctor is insisting that I be discharged.
What should I do?

Zhu Ruo Qiao, 40~49 year old female. Ask Date: 2021/01/18

Dr. Zhang Junwei reply Neurosurgery

After surgery, the emergence of new symptoms usually indicates that there may be an issue in certain areas.
It is advisable to discuss any subsequent treatment for your condition with the original surgeon, as other physicians typically do not intervene in such cases.

Reply Date: 2021/01/18

More Info

Managing post-surgery complications after cervical disc replacement can be a challenging process, especially when symptoms persist or worsen after the procedure. It is crucial to understand that while some discomfort and complications can be expected following surgery, significant or prolonged symptoms warrant further investigation and management.

In your case, it appears that you underwent cervical disc replacement surgery due to a ruptured disc at levels C5 and C6, which caused severe pain and numbness radiating down your left arm. While it is encouraging that the immediate symptoms related to the left side were alleviated, the emergence of new symptoms post-surgery, such as pain when lying flat, right shoulder discomfort, and inability to sleep comfortably, raises concerns that should not be overlooked.

Possible Causes of Post-Surgery Symptoms
1. Postoperative Inflammation: After any surgical procedure, inflammation is a natural response. This can lead to swelling and discomfort, which may contribute to the symptoms you are experiencing. In some cases, inflammation can irritate nearby nerves, leading to pain and discomfort.

2. Nerve Compression: If there was pre-existing nerve compression due to the ruptured disc, it is possible that the surgery did not fully relieve the pressure on the affected nerves. Additionally, scar tissue formation post-surgery can also lead to nerve irritation or compression.

3. Muscle Spasms: The muscles around the surgical site may go into spasm as a protective mechanism, leading to pain and discomfort, especially when changing positions or attempting to lie flat.

4. Surgical Technique: Depending on the surgical technique used, there may be variations in recovery experiences. Some patients may experience more significant discomfort based on how the surgery was performed.

5. Psychological Factors: Anxiety and stress related to the surgery and recovery can also manifest as physical symptoms, including muscle tension and pain.

Recommendations for Management
1. Follow-Up with Your Surgeon: It is essential to maintain open communication with your surgeon regarding your symptoms. If you feel that your concerns are not being adequately addressed, consider seeking a second opinion from another spine specialist. They may provide additional insights or alternative treatment options.

2. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can guide you through exercises designed to strengthen the neck and shoulder muscles, improve flexibility, and reduce pain. They can also teach you proper body mechanics to minimize strain on your neck.

3. Pain Management: If your current pain management regimen is not effective, discuss this with your healthcare provider. They may consider adjusting your medications or exploring alternative pain management strategies, such as nerve blocks or other interventional procedures.

4. Activity Modification: While it is important to remain active, you may need to modify your activities to avoid exacerbating your symptoms. Gradually increasing your activity level while paying attention to your body’s signals can help you find a balance.

5. Sleep Positioning: Finding a comfortable sleeping position is crucial for recovery. You might benefit from using a specialized cervical pillow or adjusting your sleeping environment to support your neck properly.

6. Mind-Body Techniques: Techniques such as mindfulness, meditation, or gentle yoga can help manage pain and reduce stress, which may contribute to muscle tension and discomfort.

Conclusion
In summary, while it is common to experience some discomfort after cervical disc replacement surgery, persistent or worsening symptoms should be thoroughly evaluated. Engaging with your healthcare team, including your surgeon and physical therapist, is vital for effective management. Remember, recovery is often a gradual process, and patience, along with appropriate interventions, can lead to improvement over time. If symptoms do not improve or worsen, do not hesitate to seek further evaluation to ensure that there are no underlying issues that need to be addressed.

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