Post-Surgery Insights: Recovery After Disc Herniation Surgery

Q: Post-Surgery Insights: Recovery After Disc Herniation Surgery

Hello： You have many questions after your surgery, but since Dr. <br>Lai did not perform your surgery and I did not personally examine you, I will do my best to respond to you. <br>(A bit of a doctor's curiosity： Who was your surgeon? If you were my patient, I would answer all yo

Postoperative care after disc herniation removal surgery?

Hello, doctor.
I am 36 years old and have a herniated disc.
I underwent decompression surgery about a month ago (simple decompression).
The pre-operative MRI is as follows: https://imgur.com/a/cEEz4Dh.
My surgeon informed me that the protruding part was about 1.4 cm, and during the surgery, they would remove an additional 5 mm to allow for space.
I have a few questions for you:
1.
About two weeks post-surgery until now, I occasionally experience lower back pain.
Could this be due to the annulus fibrosus healing?
2.
Around three weeks post-surgery, I was advised by the occupational nurse at my company that if I wasn't in significant pain, I could stop taking pain medication.
I stopped taking the pain medication; does it have anti-inflammatory effects? Does it help prevent post-operative adhesions to some extent?
3.
Currently, about four weeks post-surgery, when I sleep on my side (with a pillow between my knees), I wake up with tightness and soreness in my lower back.
Should I change my sleeping position? I have purchased an electric bed with three motors and have tried elevating the knee area; does this reduce the stress on my spine?
4.
After the annulus fibrosus heals, what percentage of its original strength does it retain? Does the nucleus pulposus still leak moisture after the annulus heals? Will the nucleus regenerate?
5.
Is my L4-L5 disc also close to failing? After decompression at L5-S1, will the pressure on L4-L5 increase?
6.
Post-surgery, I often feel discomfort in the corners of my eyes, and my partner has noticed blood vessels.
Could this be related to my high-protein diet post-surgery (three eggs a day, high cholesterol)?
7.
This is a somewhat unrelated question: several doctors who reviewed my MRI before and after surgery mentioned that my condition must have resulted from a fall, impact, or heavy lifting.
I am confused as to why they would mention this without me asking about it.
Thank you for your answers.

HuanYu, 30~39 year old female. Ask Date: 2022/01/30

Dr. Lai Zhaokang reply Neurosurgery

Hello: You have many questions after your surgery, but since Dr.
Lai did not perform your surgery and I did not personally examine you, I will do my best to respond to you.
(A bit of a doctor's curiosity: Who was your surgeon? If you were my patient, I would answer all your questions and provide repeated education.
I would not let my postoperative patients leave with so many doubts.)
1.
Postoperative lower back pain: You had surgery that only involved the removal of part of the cartilage, without reinforcement using artificial implants.
This may weaken the mechanical support of the spine, potentially leading to lower back pain.
You should now wait for the annulus fibrosus to heal, which will gradually improve the mechanical support of the spine.
2.
The pain medications typically prescribed by doctors are mostly anti-inflammatory analgesics.
As your occupational health nurse suggested, if you are not experiencing discomfort, you can reduce or stop the medication.
There is no medical literature confirming whether analgesics have any effect in preventing postoperative adhesions.
3.
Elevating the knee can relieve pressure on the lumbar spine.
If you sleep on your side with a pillow between your knees and wake up with tightness in your lower back, should you change your sleeping position? Answer: If you feel sore, change your position and sleep again.
4.
What percentage of the original strength does the annulus fibrosus have after healing? Answer: Ask your doctor how much was removed initially and how much remains.
Additionally, does the nucleus pulposus still leak moisture after the annulus fibrosus heals? Answer: Yes.
Will the nucleus pulposus regenerate? Answer: No.
5.
Is my L4-L5 disc also close to failing? Answer: If it appears dark, it indicates dehydration and degeneration, but it is not yet failing.
Will decompression at L5-S1 increase the pressure on L4-L5? Answer: Not necessarily; it depends on what your original doctor did at L5-S1.
6.
After surgery, I often feel discomfort in the corners of both eyes, and my spouse says there are blood vessels.
Could this be related to my high-protein diet post-surgery (three eggs a day, high cholesterol)? Answer: See an ophthalmologist for examination.
Since you know that three eggs a day leads to high cholesterol—then listen to your wife.
7.
Several doctors reviewed my MRI before and after surgery and informed me that my condition must have been caused by a fall, impact, or heavy lifting.
I am confused as to why they would tell me this when I did not ask.
Answer: This indicates that the intervertebral disc (cartilage) has ruptured or even displaced fragments downward.
Generally, this is caused by a significant force, but being overweight or having poor posture can also contribute.
Best wishes.

Director of the Department of Spine Neurosurgery, Changhua Hospital, Dr.
Lai Chao-Kang.

Reply Date: 2022/01/30

More Info

Post-surgery recovery after a disc herniation surgery is a critical phase that requires careful attention to various factors affecting healing and overall well-being. Based on your questions and the context provided, let’s delve into each of your concerns.

1. Lower Back Pain Post-Surgery: Experiencing lower back pain a few weeks after surgery can be common. This discomfort may indeed be related to the healing process of the annulus fibrosus (the outer layer of the intervertebral disc). As the tissue heals, it can cause inflammation and discomfort. Additionally, muscle spasms or tension in the surrounding muscles can contribute to this pain. It’s essential to monitor the intensity and duration of this pain and report any significant changes to your physician.

2. Pain Medication and Anti-inflammatory Effects: Over-the-counter pain medications, such as NSAIDs (non-steroidal anti-inflammatory drugs), do have anti-inflammatory properties. While they primarily serve to alleviate pain, they can also help reduce inflammation around the surgical site, which may indirectly aid in preventing adhesions. However, it’s crucial to follow your physician's advice regarding medication use, as prolonged use of painkillers can lead to other complications.

3. Sleeping Position and Spinal Pressure: It’s not uncommon to experience discomfort when sleeping in certain positions post-surgery. If you find that side sleeping with a pillow between your knees leads to tightness or discomfort in your lower back, it may be beneficial to experiment with different sleeping positions. Elevating your knees with a wedge or an adjustable bed can help reduce pressure on the lumbar spine, promoting better spinal alignment and potentially alleviating discomfort.

4. Strength of the Annulus Fibrosus Post-Healing: The strength of the annulus fibrosus after healing can vary. Typically, it may regain about 70-80% of its original strength, but this can depend on various factors, including the extent of the injury and individual healing processes. The nucleus pulposus (the inner gel-like core of the disc) can still lose hydration over time, and while it does not regenerate in the same way as other tissues, maintaining a healthy lifestyle can support its function.

5. Pressure Dynamics Between L4-L5 and L5-S1: After a decompression surgery at L5-S1, there can be changes in the load distribution across the lumbar spine. It’s possible that the pressure on L4-L5 may increase due to the altered mechanics of the spine. Regular follow-up with your healthcare provider is essential to monitor these dynamics and ensure that the adjacent discs are not experiencing undue stress.

6. Eye Discomfort Post-Surgery: The discomfort in your eyes, especially if accompanied by redness, may not be directly related to your surgery or dietary changes. However, high-protein diets, particularly those high in cholesterol, can lead to various health issues. It’s advisable to consult with a healthcare professional regarding your dietary habits and any potential side effects.

7. Comments from Physicians Regarding Injury Mechanism: Physicians often provide insights into potential causes of disc herniation based on clinical experience and the nature of the injury observed in imaging studies. They may mention trauma or heavy lifting as common causes to help you understand the context of your condition and to encourage preventive measures in the future.

In summary, recovery from disc herniation surgery is a multifaceted process that requires attention to pain management, physical therapy, and lifestyle adjustments. It’s crucial to maintain open communication with your healthcare providers to address any concerns and to ensure a smooth recovery. Regular follow-ups will help monitor your progress and adjust treatment plans as necessary.

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