Post-Surgery Weakness in Legs After Spinal Spondylolisthesis Treatment

Postoperative weakness in the legs after spinal slip surgery?

Hello doctor, my mother has been experiencing leg numbness for nearly 6-7 years.
Last April, she underwent surgery for a slipped disc at the L4-L5 level.
The surgeon indicated that the slipped portion was pressing on some nerves, causing the numbness in her right leg (she does not experience any pain, just numbness, which extends from her calf to the sole of her foot).
However, about two months after the surgery, she began to feel significant weakness in her left leg; she can barely walk 10 meters before her legs give out.
She has been attending physical therapy for several months and has been doing the exercises prescribed by the therapist at home.
Despite this, it has been 9 months, and her numbness has not improved (she even feels it deep in her bones), and her other leg has become weak.
My mother is now in despair and feels hopeless.
Which specialty should we seek information from next?

Miss Lin, 30~39 year old female. Ask Date: 2022/01/04

Dr. Wang Shouji reply Orthopedics

Hello, prolonged nerve compression can lead to difficulties in recovering certain functions such as weakness and numbness.
However, after surgery, there is usually a gradual improvement.
It is essential to first confirm whether the nerve compression has been relieved or if new issues have arisen.
Changhua Hospital cares about your health.
Wang Shou-ji.

Reply Date: 2022/01/04

More Info

Post-surgery weakness in the legs, particularly after spinal surgery for spondylolisthesis, can be a complex issue that requires careful evaluation and management. Your mother's situation, characterized by persistent leg weakness and numbness, is not uncommon among patients who have undergone spinal surgery. Here’s a comprehensive overview of potential causes, diagnostic considerations, and treatment options.

Understanding the Symptoms
1. Persistent Numbness and Weakness: After surgery, it is not unusual for patients to experience residual symptoms, especially if there was pre-existing nerve compression. The numbness in your mother's right leg may be due to nerve damage or irritation that occurred prior to the surgery. The development of weakness in the left leg post-surgery could suggest a few possibilities:
- Postoperative Complications: Sometimes, surgical interventions can lead to new issues, such as nerve irritation or scar tissue formation (adhesions) that can affect nerve function.

- Muscle Deconditioning: Prolonged inactivity or limited mobility post-surgery can lead to muscle weakness, particularly if rehabilitation efforts are not sufficient or if the patient is hesitant to engage in physical activity due to fear of pain or re-injury.

- Neurological Issues: Conditions like peripheral neuropathy or other neurological disorders could also contribute to these symptoms.

Diagnostic Steps
Given the complexity of your mother's symptoms, further evaluation is essential. Here are some recommended steps:
1. Follow-Up Imaging: An MRI or CT scan may be warranted to assess for any postoperative complications, such as herniated discs, scar tissue, or other structural issues that could be compressing nerves.

2. Neurological Evaluation: Consulting a neurologist can provide insights into whether there are underlying neurological conditions contributing to her symptoms. They may recommend nerve conduction studies or electromyography (EMG) to assess nerve function and muscle response.

3. Physical Therapy Assessment: A thorough evaluation by a physical therapist specializing in post-surgical rehabilitation can help determine if her current rehabilitation program is adequate or if modifications are needed.

Treatment Options
1. Physical Therapy: Continuing with physical therapy is crucial. A tailored rehabilitation program focusing on strength training, flexibility, and balance can help improve muscle strength and coordination. If her current therapist is not meeting her needs, seeking a second opinion or a different therapist may be beneficial.

2. Pain Management: If your mother experiences discomfort during rehabilitation, discussing pain management strategies with her healthcare provider can help her engage more fully in therapy.

3. Medication Review: A review of her current medications, including any pain relievers or neuropathic pain medications, may be necessary. Medications such as gabapentin or pregabalin can be effective for nerve-related pain and may help alleviate some of her symptoms.

4. Surgical Consultation: If conservative measures do not yield improvement, a consultation with a neurosurgeon or orthopedic spine specialist may be necessary to evaluate the possibility of additional surgical intervention, especially if there is evidence of nerve compression or other complications.

Emotional Support
It’s important to acknowledge the emotional toll that chronic pain and disability can take on patients and their families. Encouraging your mother to engage in support groups or counseling can provide her with emotional support and coping strategies.

Conclusion
In summary, your mother’s ongoing symptoms after spinal surgery warrant a comprehensive approach involving further diagnostic evaluation, potential adjustments to her rehabilitation program, and possibly a referral to a neurologist or spine specialist. With the right support and treatment, there is hope for improvement in her condition. It’s essential to maintain open communication with her healthcare team to ensure that her concerns are addressed and that she receives the best possible care.

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