Managing Nerve Pain and Swelling in Elderly Patients After Spine Surgery

Tightness in the thigh muscles, numbness, and mild edema in the legs?

My mother, who is 88 years old, participated in a volunteer trip on November 14, where she walked too much, resulting in foot pain and nerve compression that prevented her from sleeping and standing.
During this period, she relied on pain injections and pain medication to cope.
Later, on December 6, she underwent surgery on her lumbar spine (L2, L3, L4, and L5), which led to some improvement.
She is currently able to use a walker to move slowly.
However, she still experiences numbness in her foot, and the muscles in her right leg feel as if they are being pulled up to her hip, causing pain and discomfort.
Additionally, there is mild swelling in her foot, and she has a urinary bag, which is quite distressing for her.
I would like to ask the doctor if this condition (tightness and numbness in the right leg) can improve.
Thank you for your assistance.

amy, 60~69 year old female. Ask Date: 2024/01/09

Dr. Jiang Junyi reply Neurology

Dear Ms.
Amy,
You mentioned that your mother is experiencing numbness in her feet, along with a sensation that the tendons in her right foot seem to be pulling up towards her buttocks.
This may indicate compression of the lumbar nerve roots.
Post-surgery, it is common to encounter issues with tissue swelling, and typically, after two weeks, the numbness caused by nerve compression will improve.

It is advisable that once her condition stabilizes, she should learn the correct postures for walking, standing, sitting, and lying down.
If symptoms persist, it is recommended to supplement with B vitamins and consider medications for neuropathic pain, such as Lyrica.

I suggest that she consult with a neurologist or a rehabilitation specialist for further evaluation (such as nerve conduction studies and electromyography) and treatment.
The physician will prescribe medications and rehabilitation therapy based on her condition.
Thank you for your inquiry.
If you have any further questions, feel free to discuss them! Wishing you good health and peace.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital

Reply Date: 2024/01/09

More Info

Managing nerve pain and swelling in elderly patients after spine surgery can be a complex process, especially considering the unique challenges faced by older adults. In your mother’s case, her history of nerve compression and subsequent surgery has led to persistent symptoms such as numbness, pain, and swelling in her right leg. Here’s a comprehensive approach to managing her condition.

Understanding the Symptoms
1. Nerve Pain and Compression: After spinal surgery, it is common for patients to experience nerve pain due to inflammation, scar tissue formation, or residual nerve compression. The fact that your mother felt pain and numbness prior to surgery suggests that her nerves were under significant stress, which may take time to heal even after the surgical intervention.

2. Swelling and Edema: The mild swelling in her leg could be attributed to several factors, including post-surgical inflammation, reduced mobility, or even fluid retention due to her reliance on medications. Swelling can exacerbate feelings of discomfort and may contribute to the sensation of tightness in her leg.

Management Strategies
1. Medication Management:
- Pain Relief: Continue using prescribed pain medications, but consult her physician about adjusting dosages or switching to different medications if the current regimen is ineffective. Non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce inflammation and pain.

- Neuropathic Pain Medications: Medications such as gabapentin or pregabalin can be effective for nerve pain and may be worth discussing with her healthcare provider.

2. Physical Therapy:
- Engaging in a structured physical therapy program can significantly improve her mobility and reduce pain. A physical therapist can design a program tailored to her needs, focusing on gentle stretching, strengthening exercises, and balance training. This can help alleviate tightness in her leg and improve overall function.

3. Compression Therapy:
- If her swelling is significant, the use of compression stockings may help reduce edema. These stockings can promote better circulation in her legs, which may alleviate some of the discomfort she is experiencing.

4. Elevation and Rest:
- Encourage her to elevate her legs when sitting or lying down. This can help reduce swelling and improve circulation. Additionally, ensuring she gets adequate rest is crucial for recovery.

5. Hydration and Nutrition:
- Maintaining proper hydration and a balanced diet rich in anti-inflammatory foods (like fruits, vegetables, and omega-3 fatty acids) can support her healing process. Proper nutrition is essential for recovery, especially in elderly patients.

6. Follow-Up Care:
- Regular follow-ups with her surgeon or primary care physician are essential. They can monitor her recovery, assess the need for further imaging (like an MRI) to rule out any complications, and adjust her treatment plan as necessary.

7. Alternative Therapies:
- Some patients find relief through complementary therapies such as acupuncture, massage, or yoga. These can help manage pain and improve mobility, but should be approached with caution and discussed with her healthcare provider.

Conclusion
In summary, while your mother’s symptoms of nerve pain and swelling are concerning, there are multiple avenues for management and improvement. A combination of medication, physical therapy, and lifestyle adjustments can significantly enhance her quality of life. It’s crucial to maintain open communication with her healthcare team to ensure that her treatment plan is effective and tailored to her specific needs. With time and appropriate care, there is a good chance that her symptoms will improve, allowing her to regain more independence and comfort in her daily activities.

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