Post-Surgery Pain and Complications from L4-L5, L5-S1 Disc Herniation

Q: Post-Surgery Pain and Complications from L4-L5, L5-S1 Disc Herniation

Dear Chen： Regarding your questions, my responses are as follows： 1. <br>Both the fixation screws and the support frame are methods for stabilizing the spine; they simply have different developmental timelines, and there is no theoretical error in this. <br>2. <br>It is not possi

The intervertebral discs at L4-L5 and L5-S1 have herniated and have been surgically treated?

Hello, Dr.
Zhang.
I have suffered from a car accident resulting in herniation of the intervertebral discs at L4-L5 and L5-S1, which severely affects my daily life.
I have undergone rehabilitation for over a year without improvement.
After consulting with my doctor, I was advised to undergo surgery to remove the intervertebral discs and insert one fixation screw and cage at each level.
However, it has been nearly eight months since the surgery, and not only has the screw at L4-L5 shifted, but I also continue to endure pain, which significantly restricts my mobility.
I can hardly bear the pain when lying flat and trying to get up.
I have been following up with my doctor and have undergone high-frequency thermal therapy, but there has been no improvement.
During my recent visit, the doctor showed me X-rays of another patient who had one level operated on, where two fixation screws and a support frame were placed.
In my case, I had two levels operated on but only one screw placed at each level without a support frame.
The doctor suggested that I undergo another surgery to insert a support frame for stabilization.
I have a few questions:
1.
Is it standard practice to simultaneously insert a support frame when performing such surgeries on unstable intervertebral discs? Is the doctor's approach correct?
2.
Is it possible to improve my current condition without surgery?
3.
If surgery is necessary, should I first undergo a CT or MRI to confirm the cause of the pain before determining the need for another operation?

Chen, 30~39 year old female. Ask Date: 2008/03/10

Dr. Zhang Yuanyi reply Neurosurgery

Dear Chen: Regarding your questions, my responses are as follows: 1.
Both the fixation screws and the support frame are methods for stabilizing the spine; they simply have different developmental timelines, and there is no theoretical error in this.
2.
It is not possible to determine whether surgery is indicated based solely on a description; clinical neurological examination results must be evaluated.
3.
Only based on the clinical neurological examination can we consider whether to perform imaging studies.
Wishing you peace and health.
Sincerely, Dr.
Zhang Yuan-yi, Attending Physician, Department of Neurosurgery, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2008/03/10

More Info

Post-surgery complications following a lumbar disc herniation, particularly at the L4-L5 and L5-S1 levels, can be quite challenging and frustrating for patients. Your situation, characterized by persistent pain and functional limitations even after surgical intervention, is not uncommon. Let's address your concerns systematically.

1. Surgical Considerations: Use of Support Structures
In spinal surgeries, particularly those involving disc herniation and stabilization, the decision to use support structures such as cages or rods is crucial. These devices are intended to provide stability to the spine after the removal of a herniated disc. The use of a cage can help maintain the height of the intervertebral space and prevent adjacent segment degeneration. If your surgeon opted not to use a support structure during your initial surgery, it may have contributed to the instability you are experiencing now. Generally, for multi-level surgeries, the use of additional support is often recommended to ensure proper alignment and stability of the spine.

2. Non-Surgical Management Options
While surgical intervention is sometimes necessary, there are non-surgical options that can help manage pain and improve function. These may include:
- Physical Therapy: A tailored rehabilitation program focusing on strengthening the core muscles, improving flexibility, and enhancing posture can be beneficial.
- Pain Management: Medications such as NSAIDs, muscle relaxants, or nerve pain medications (like gabapentin) may help alleviate pain.

- Injections: Epidural steroid injections or nerve blocks can provide temporary relief from inflammation and pain.

- Alternative Therapies: Techniques such as acupuncture, chiropractic care, or massage therapy might offer some relief.

However, if these conservative measures have been exhausted without improvement, surgical options may need to be reconsidered.

3. Diagnostic Imaging Before Reoperation
Before proceeding with another surgery, it is essential to conduct thorough imaging studies, such as a CT scan or MRI. These studies can help identify the exact cause of your ongoing pain, whether it is due to hardware failure, adjacent segment disease, or other complications. Understanding the underlying issue is critical for planning the next steps in your treatment.

Conclusion
Your situation is complex, and it is understandable to feel overwhelmed. It is essential to have open and honest discussions with your healthcare provider regarding the potential benefits and risks of further surgery. If you feel uncertain about your current surgeon's recommendations, seeking a second opinion from another spine specialist could provide additional insights and options.

In summary, while surgical intervention may be necessary, exploring all non-surgical avenues and ensuring thorough diagnostic evaluation before any further procedures is crucial. Your quality of life is paramount, and addressing both the physical and emotional aspects of your condition is essential for your overall well-being.

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