Post-Operative Consultation for L5-S1 Fusion Surgery Complications

Q: Post-Operative Consultation for L5-S1 Fusion Surgery Complications

Hello： 1. <br>Indeed, some individuals may experience symptoms on the opposite side after a dislocation is reduced, which could be due to temporary discomfort in the new environment following the renovation of an old house. <br>2. <br>It would be advisable to discuss this further

Postoperative Consultation for L5-S1 Surgery

Hello Dr.
Lai,
I previously underwent an anterior spinal fusion surgery due to grade II spondylolisthesis at the L5-S1 level.
(Before the surgery, I experienced persistent pain on the left side, while the right side had no symptoms.) After the surgery, I had a severe reaction to the anesthesia, resulting in intense nausea and vomiting, and I spent about 5 to 6 hours in the recovery room.
Upon returning to the ward, I continued to experience vomiting and dizziness.
The vomiting involved a lot of exertion.
On the fifth postoperative day, after using the restroom in the morning, I began to feel slightly dizzy.
Later, while being transported in a wheelchair for an X-ray, I experienced severe headaches, blurred vision, eyelid tremors, and lip tremors.
Upon returning, my condition did not improve while sitting.
I then notified the nurse, who asked me to lie flat.
Once I lay down, my headache immediately disappeared.
However, whenever I stood for about a minute, I would experience a feeling of head pressure, tinnitus, and when speaking with more effort, my lips would tremble.
The doctor later mentioned that since the surgery did not involve opening the area, there should not be any cerebrospinal fluid leakage, but my described symptoms were quite typical.

Fourteen days post-surgery, I began to experience severe pain on the right side, starting from the hip down to the sole of the big toe and the top of the foot.
At night, when lying flat for about 2 to 3 hours, I would wake up in pain.
The entire leg felt very swollen, painful, hot, and sore.
I reported this during my first follow-up visit, but it was suggested to observe the postoperative condition.
At the second follow-up, the situation remained unchanged, and I could only sleep for 2 to 3 hours before waking up in pain.
Subsequently, an MRI was arranged.

The MRI results described:
Result: Y
Finding: MRI of the lumbar spine with pulse sequences: Sagittal section: T1WI, T2WI, STIR; Axial section: T1WI, T2WI
Findings:
1.
Various osteoarthritis changes in the bilateral facet joints.

2.
Status post internal fixation and cage implant over L5-S1.

3.
Presence of a 28mm fluid collection lesion abutting the anterior border of the L5-S1 disc.
Differential diagnosis includes ruptured disc, postoperative change...
Suggest follow-up.

4.
Grade I spondylolisthesis of L5 on S1.

5.
L5-S1: Presence of mild right neuroforaminal stenosis.

Impression: As described above.
I would like to ask:
1.
Regarding the finding of a 28mm fluid collection lesion abutting the anterior border of the L5-S1 disc, is this related to the surgery, or could it possibly indicate a cerebrospinal fluid leak? Does it need to be addressed? The doctor at my follow-up visit said he was unsure what it was.

2.
Initially, I had discomfort on the left side, but could the addition of the cage after surgery have caused narrowing of the neuroforamen on the right side?
3.
Should I seek another neurosurgeon, or continue to consult the orthopedic surgeon who performed the surgery for assistance?
I apologize for the lengthy message, but I wanted to clearly describe the situation.
Thank you for your patience in reading and responding.
Thank you.

Amber, 40~49 year old female. Ask Date: 2024/05/02

Dr. Lai Zhaokang reply Neurosurgery

Hello: 1.
Indeed, some individuals may experience symptoms on the opposite side after a dislocation is reduced, which could be due to temporary discomfort in the new environment following the renovation of an old house.
2.
It would be advisable to discuss this further with the original orthopedic surgeon.
3.
If there is no improvement after 1-2 months, seeking a second opinion from a spine specialist may be beneficial, as there could be room for adjustments.
Best wishes, Dr.
Lai Chao-Kang, Changhua Hospital.

Reply Date: 2024/05/02

More Info

Post-operative complications following L5-S1 fusion surgery can be multifaceted and may vary significantly from patient to patient. Based on your description, it seems you are experiencing a range of symptoms that could be related to both the surgical procedure and the underlying conditions that necessitated the surgery in the first place.

1. Fluid Collection: The presence of a 28mm fluid collection lesion adjacent to the anterior border of the L5-S1 disc raises several considerations. This could be a post-operative change, such as a seroma or hematoma, which is a localized collection of fluid that can occur after surgery. However, it could also indicate a more serious issue, such as a cerebrospinal fluid (CSF) leak, especially if the fluid is clear and under pressure. CSF leaks can occur if the dura mater (the protective covering of the spinal cord) is inadvertently punctured during surgery. While your surgeon indicated that the surgery did not involve opening the dura, it is still essential to monitor this fluid collection. Follow-up imaging and possibly a consultation with a neurosurgeon may be warranted to determine the nature of this fluid and whether intervention is necessary.

2. Neuroforaminal Stenosis: The development of mild right neuroforaminal stenosis post-surgery could indeed be a consequence of the surgical intervention, particularly if the placement of hardware or the fusion itself has altered the anatomy of the spine. This narrowing can lead to nerve compression, which might explain the symptoms you are experiencing on the right side, including pain and weakness. It is not uncommon for patients to experience changes in symptoms post-surgery, especially if the surgical site alters the dynamics of the surrounding structures.

3. Consulting Specialists: Given the complexity of your symptoms and the findings from your MRI, it may be beneficial to seek a second opinion from a neurosurgeon or a spine specialist. They can provide a different perspective on your condition and may suggest alternative treatment options or further diagnostic evaluations. It is crucial to have a comprehensive understanding of your situation, especially if you are experiencing persistent pain and discomfort.

4. Post-Operative Symptoms: The symptoms you describe, such as dizziness, nausea, and visual disturbances, could be related to several factors, including the effects of anesthesia, post-operative pain medication, or even positional changes after surgery. The fact that lying down alleviates your headache suggests that there may be a positional component to your symptoms, potentially related to intracranial pressure changes or fluid shifts.

5. Long-Term Considerations: As you continue to recover, it is essential to engage in a structured rehabilitation program to strengthen your back and improve your overall function. Persistent pain and weakness can lead to compensatory movement patterns that may exacerbate your condition. Physical therapy can be instrumental in addressing these issues and improving your quality of life.

In conclusion, while post-operative complications can be concerning, it is vital to maintain open communication with your healthcare providers. Regular follow-ups, imaging studies, and possibly consultations with specialists will help ensure that any complications are addressed promptly and effectively. Your health and well-being are paramount, and taking proactive steps in your recovery will be beneficial in the long run.

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