Lumbar Burst Fractures and Nerve Injury Management

Lumbar vertebra burst fracture with spinal nerve injury?

Hello Doctor:
1.
I underwent lumbar spine surgery approximately ten years ago, during which I had a total of three to four surgeries.
Recently, I have been experiencing lower back pain, leg numbness, and a burning sensation in my legs.
I feel weakness in both my thighs, calves, toes, and from the back of my hands to my fingers.
Despite continuously following up with my primary physician, I was ultimately told that they were sorry but did not know how to help me.
I was referred to a neurosurgeon and a pain specialist, but both doctors advised against surgery on my old injuries.
2.
I have held a disability certificate for nearly ten years.
However, my doctor mentioned that they cannot assist with my re-evaluation at this time.
In August of this year, I underwent an epidural steroid injection for nerve block, and the physician who performed the procedure advised me to return to the surgeon who initially operated on me.
They later referred me to the neurosurgeon and pain specialist, as I feel my legs are gradually becoming weaker.
3.
I have not given up and sought a second opinion from another neurosurgeon, who stated that my adhesions are too severe and advised me to return to the original surgeon for treatment and evaluation.
4.
I am perplexed as to why I trusted that physician for over ten years, only to be told they do not know how to treat my condition and cannot assist with my evaluation.
I now feel lost in seeking help and do not know where to find a doctor who can assist me with my health issues.

Jie Ke, 30~39 year old female. Ask Date: 2009/09/17

Dr. Zhang Yuanyi reply Neurosurgery

Dear Jack,
After surgery for lumbar nerve compression, it is common for some neurological symptoms to persist.
This is because the relief of nerve compression does not always guarantee a return to original function.
Currently, there are no specific treatment options available, and determining the exact cause can be quite challenging.
Given your lengthy medical history, I recommend discussing this further with your original surgeon.
Wishing you peace and health,
Dr.
Zhang Yuanyi
Attending Physician, Department of Neurosurgery
Taoyuan General Hospital, Ministry of Health and Welfare

Reply Date: 2009/09/17

More Info

Lumbar burst fractures are serious injuries that can lead to significant complications, including nerve damage. These fractures occur when a vertebra in the lumbar spine is subjected to high-impact forces, causing it to shatter. This type of injury can result in spinal instability and may compress or damage the spinal cord and surrounding nerves, leading to symptoms such as pain, weakness, and sensory changes in the lower extremities.

In your case, it appears that you have undergone multiple surgeries over the past ten years, which suggests a history of significant spinal issues. The symptoms you are currently experiencing—such as lower back pain, leg weakness, and sensory changes—could be indicative of nerve involvement, possibly due to scar tissue formation or ongoing compression of the nerves in the lumbar region.

When dealing with chronic pain and neurological symptoms following a lumbar burst fracture, it is essential to have a comprehensive evaluation. Here are some considerations and recommendations based on your situation:
1. Consultation with Specialists: It seems you have already seen various specialists, including neurosurgeons and pain management doctors. If these specialists have suggested that surgery is not advisable due to the risk of complications, it may be beneficial to seek a second opinion from a different neurosurgeon who specializes in complex spinal cases. They may have different insights or treatment options.

2. Pain Management: Since you have undergone steroid nerve blocks, it indicates that you are already exploring pain management strategies. Other options include physical therapy, which can help strengthen the muscles around the spine and improve mobility. Additionally, modalities such as acupuncture, chiropractic care, or transcutaneous electrical nerve stimulation (TENS) may provide relief.

3. Physical Rehabilitation: Engaging in a structured rehabilitation program can be crucial. A physical therapist can design a tailored exercise program that focuses on strengthening your core and lower extremities, improving flexibility, and enhancing overall function. This can help alleviate some of the pain and weakness you are experiencing.

4. Monitoring for Neurological Changes: Given your symptoms of weakness and sensory changes, it is vital to monitor for any progression. If you notice worsening symptoms, such as increased weakness, loss of bowel or bladder control, or severe pain, it is essential to seek immediate medical attention.

5. Psychological Support: Living with chronic pain and disability can take a toll on mental health. Consider seeking support from a mental health professional who can help you cope with the emotional aspects of your condition.

6. Exploring Alternative Therapies: Some patients find relief through alternative therapies such as mindfulness meditation, yoga, or tai chi, which can help manage pain and improve overall well-being.

7. Patient Advocacy: If you feel that your concerns are not being adequately addressed, consider reaching out to patient advocacy groups or organizations that specialize in spinal injuries. They can provide resources and support in navigating the healthcare system.

In conclusion, managing the aftermath of a lumbar burst fracture requires a multidisciplinary approach. It is crucial to continue advocating for your health and exploring all available options. While it can be frustrating to feel like you are not receiving the help you need, persistence in seeking care and exploring different avenues can ultimately lead to improved outcomes.

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