Post-Spinal Surgery: Why Can't My Dad Move His Ankles and Toes?

Q: Post-Spinal Surgery: Why Can't My Dad Move His Ankles and Toes?

Hello： 1. <br>The symptoms may suggest involvement of the L4 and L5 nerve roots, resembling a temporary malfunction, possibly due to nerve edema or adaptation issues to a new environment. <br>2. <br>It is recommended to consult with the original surgeon regarding the need for fur

Inability to move the ankle and toes following spinal surgery?

Hello Doctor: My father underwent minimally invasive surgery for lumbar spondylolisthesis at levels L3, L4, and L5 on June 13, where screws were placed.
However, since the surgery, he has been unable to move his legs, ankles, and toes independently, although he has sensation.
His thighs are functioning normally.
Before the surgery, he was able to walk and exercise normally, but now he cannot walk due to what seems to be foot drop in his ankles.
The surgeon stated that the surgery was successful and advised us to continue rehabilitation and wait for nerve recovery.
However, it has been over a month, almost two months, and there has not been much progress in his ankles and toes.
What could be the issue? What should we do next? We have been diligently participating in rehabilitation, but there has been little improvement, and we are very concerned that the longer this takes, the more we risk missing the critical treatment window and becoming unable to walk.
Please help us understand what steps we should take next.
Thank you for your response.

Eva, 40~49 year old female. Ask Date: 2024/07/22

Dr. Lai Zhaokang reply Neurosurgery

Hello: 1.
The symptoms may suggest involvement of the L4 and L5 nerve roots, resembling a temporary malfunction, possibly due to nerve edema or adaptation issues to a new environment.
2.
It is recommended to consult with the original surgeon regarding the need for further examination and treatment, and to continue rehabilitation exercises and training.
3.
If progress in treatment is limited, consider consulting other specialized spine physicians.
Wishing you a speedy recovery.
By Dr.
Lai Chao-Kang, Chief of Spine Surgery, Changhua Hospital.

Reply Date: 2024/07/22

More Info

Post-spinal surgery complications, particularly regarding the inability to move the ankles and toes, can be concerning for both patients and their families. In your father's case, it appears that he is experiencing a condition known as "foot drop," which is characterized by the inability to lift the front part of the foot due to weakness or paralysis of the muscles that control ankle dorsiflexion. This condition can arise from several factors related to spinal surgery, including nerve injury, swelling, or scar tissue formation.

Understanding the Situation
1. Nerve Injury: During spinal surgery, especially in procedures involving the lumbar region, there is a risk of nerve injury. The nerves that control the movement of the lower extremities can be affected, leading to weakness or paralysis. If the nerves were compressed before surgery, they might still be recovering post-operatively.

2. Postoperative Swelling: After surgery, inflammation and swelling can occur around the surgical site, which may compress nearby nerves. This can lead to temporary loss of function in the affected areas.

3. Scar Tissue Formation: As the body heals, scar tissue can develop around the surgical site. This scar tissue can sometimes entrap nerves, leading to persistent symptoms even after the initial recovery period.

4. Muscle Atrophy: If the muscles have not been used effectively due to the inability to move, they may begin to atrophy, further complicating recovery.

Recommendations for Management
1. Continued Rehabilitation: It is crucial to continue with physical therapy. A physical therapist can provide targeted exercises to strengthen the muscles around the ankle and improve mobility. They may also use modalities such as electrical stimulation to help activate the muscles.

2. Occupational Therapy: An occupational therapist can assist with adaptive techniques and devices to help your father regain independence in daily activities, even if full mobility is not yet restored.

3. Neurological Evaluation: If significant time has passed since the surgery (over two months) without improvement, it may be beneficial to consult a neurologist. They can perform nerve conduction studies or electromyography (EMG) to assess the function of the nerves and muscles and determine if there is ongoing nerve damage.

4. Follow-Up Imaging: If there are concerns about the surgical site, follow-up imaging such as MRI or CT scans may be warranted to evaluate for any complications, such as herniated discs or other structural issues that could be impacting nerve function.

5. Patience and Monitoring: Nerve recovery can be a slow process. While it is understandable to be anxious about the timeline, it is essential to monitor progress and remain patient. Some nerve injuries can take months to heal, and improvements may be gradual.

6. Discussing Concerns with the Surgeon: Regular follow-ups with the surgeon who performed the procedure are essential. They can provide insights into what to expect during recovery and whether any additional interventions may be necessary.

Conclusion
In summary, your father's inability to move his ankles and toes post-surgery is likely related to nerve function and recovery. Continued rehabilitation, potential neurological evaluation, and regular follow-ups with his surgical team are critical steps in managing his condition. It is essential to remain proactive in seeking answers and advocating for his care, as early intervention can significantly impact recovery outcomes.

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