Post-Surgery Challenges: Recovery After Spinal Fusion

Postoperative care after spinal spondylolisthesis surgery?

My mother underwent surgery for lumbar spondylolisthesis, including bone grafting and instrumentation, at Chang Gung Memorial Hospital in Chiayi on October 3, 2023.
After the surgery, she has been unable to walk due to a lack of strength in her left leg, while her right leg has only minimal strength.
Prior to the surgery, she was able to walk, but now she cannot even get out of bed with the assistance of a walker.
The doctor mentioned that it could be gout or ankle degeneration, but it has been a week since the surgery, and she still cannot walk.
The doctor had previously assured us that she would be able to walk and run after the surgery, but now she cannot even get out of bed, and the doctors are unsure of the cause.
She is still in the hospital, and I am worried because she cannot even go to the bathroom.
What other options are available to address this situation?

Xiao Ru, 40~49 year old female. Ask Date: 2023/10/11

Dr. Shi Guozheng reply Orthopedics

Further examination may be needed to check for any neurological issues.
Generally, symptoms should improve or progress after surgery.

Reply Date: 2023/10/11

More Info

Post-surgery recovery, especially after spinal fusion, can be a complex and challenging process. Your mother's situation, following her surgery for spinal instability, raises several important considerations regarding her recovery and the management of her symptoms.

Firstly, it is essential to understand that spinal surgery, particularly fusion procedures, can lead to a range of postoperative outcomes. While many patients experience significant improvement in their symptoms, others may face complications or prolonged recovery times. In your mother's case, the inability to walk and the weakness in her legs, particularly the left one, are concerning and warrant thorough evaluation.

Understanding Post-Surgical Symptoms
1. Neurological Recovery: After spinal surgery, it is not uncommon for patients to experience neurological symptoms such as weakness, numbness, or pain in the legs. This can be due to several factors, including nerve irritation or compression that may not have been fully resolved during surgery. The fact that your mother had pre-existing conditions, such as spinal instability, may also contribute to her current symptoms.

2. Pain Management: Postoperative pain can significantly affect mobility and recovery. If your mother is experiencing severe pain, it may inhibit her ability to engage in physical therapy or even perform basic movements. Effective pain management is crucial, and it may require adjustments in her medication regimen or the addition of therapies such as physical therapy, acupuncture, or other modalities.

3. Physical Therapy: Engaging in a structured rehabilitation program is vital for recovery after spinal surgery. Physical therapists can provide tailored exercises that focus on strengthening the legs, improving balance, and enhancing overall mobility. If your mother has not yet been referred to a physical therapist, it would be beneficial to discuss this with her healthcare team.

4. Potential Complications: The symptoms you describe, such as weakness and inability to walk, could also indicate complications such as nerve damage, infection, or issues related to the surgical site. It is essential for her medical team to conduct a thorough evaluation, which may include imaging studies (like MRI or CT scans) to assess the surgical site and surrounding structures.

5. Other Medical Conditions: You mentioned that the doctor suggested possible gout or ankle degeneration as contributing factors. It is crucial to address these conditions as they can significantly impact mobility. If gout is suspected, managing uric acid levels through diet and medication may help alleviate some symptoms. Similarly, addressing any degenerative changes in the ankle may require specific interventions.

Next Steps
1. Follow-Up with Healthcare Providers: It is vital to maintain open communication with your mother's surgical team. If her current physician is unable to provide answers or solutions, seeking a second opinion from a neurologist or a spinal specialist may be beneficial. They can offer additional insights into her condition and potential treatment options.

2. Consider Comprehensive Rehabilitation: If she is still in the hospital, inquire about the possibility of starting physical therapy while she is there. Many hospitals have rehabilitation services that can begin working with patients soon after surgery to prevent complications from immobility.

3. Monitor Symptoms: Keep a detailed record of her symptoms, including any changes in pain levels, mobility, and overall function. This information can be invaluable for her healthcare team in determining the best course of action.

4. Emotional Support: The psychological impact of being unable to walk can be significant. Providing emotional support and encouraging her to engage in activities that she enjoys (within her physical limits) can help improve her mental well-being during this challenging time.

In conclusion, recovery after spinal fusion surgery can be unpredictable, and it is essential to approach your mother's situation holistically. By working closely with her healthcare providers, engaging in physical therapy, and addressing any underlying medical conditions, there is potential for improvement in her mobility and overall quality of life.

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