Post-Operative Concerns After Minimally Invasive Lumbar Discectomy

Postoperative Issues Following Minimally Invasive Lumbar Discectomy

Dear Doctor: I underwent minimally invasive lumbar discectomy surgery for a herniated disc at the L4/L5 level at Keelung Chang Gung Hospital on November 26.
It has been one week post-surgery, and I have noticed occasional pain on the outer side of my left calf, as well as decreased sensory perception in the left leg compared to the right.
Additionally, I experience a tingling sensation in the left foot.
I consulted my attending physician, who mentioned that the surgery only involved relocating the herniated disc material that was pressing on the nerve, and that the nerve compression damage has not yet recovered.
I am unsure if this is accurate or if there could be other underlying causes.
If it is indeed nerve damage, how long might it take to recover? Could you please provide me with your insights or suggest other ways to address this issue? Thank you.
Prior to the surgery, I experienced symptoms such as numbness in the outer side of my left calf and foot after sitting in a chair or lying in bed for a while.
Post-surgery, my symptoms have evolved to what I described above.
I am concerned whether there might be residual disc fragments or other reasons for my current condition.
Thank you.

Hsu Chun-Hsiang, 40~49 year old female. Ask Date: 2011/12/07

Dr. Ding Xianwei reply Neurosurgery

You have previously asked the same question.
It is normal to experience some neurological symptoms after surgery, and it will take time for recovery.
Due to insufficient information and the lack of an in-person consultation, it is not possible to assess the severity of your condition or the neurological symptoms prior to surgery, and therefore, I cannot provide specific recommendations.
Issues related to the surgery need to be addressed by the surgeon to understand the underlying problems.
I recommend that you bring complete medical records to your outpatient appointment for a detailed explanation and advice, or discuss your concerns again with your attending physician.

Reply Date: 2011/12/07

More Info

After undergoing a minimally invasive lumbar discectomy for a herniated disc at the L4/L5 level, it is not uncommon to experience post-operative symptoms such as pain, numbness, or altered sensation in the legs, particularly if there was pre-existing nerve compression. Your report of left calf pain and decreased sensation compared to the right leg is concerning but can be understood in the context of nerve recovery following surgery.

Understanding Post-Operative Symptoms
1. Nerve Recovery: When a nerve has been compressed for an extended period, it may take time for it to recover fully after the pressure is relieved. The surgeon's comment about the "stone" being moved refers to the removal of the herniated disc material that was pressing on the nerve. While this can alleviate immediate symptoms, the nerve itself may still be healing. Recovery can vary significantly from person to person, depending on the extent of nerve damage prior to surgery. It can take weeks to months for full recovery.

2. Post-Surgical Inflammation: After surgery, inflammation can occur around the surgical site and the affected nerves. This inflammation can contribute to ongoing pain and altered sensations. It is essential to monitor these symptoms as they may improve over time with appropriate care.

3. Possible Complications: While it is less common, there is a possibility of residual disc material or scar tissue formation that could continue to irritate the nerve. If symptoms persist or worsen, further imaging studies, such as an MRI, may be warranted to rule out these complications.

Recommendations for Management
1. Follow-Up Care: Regular follow-up appointments with your surgeon or a neurologist are crucial. They can assess your recovery and determine if further interventions are necessary. If symptoms do not improve within a few weeks, additional diagnostic imaging may be needed.

2. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can provide exercises that promote nerve healing and improve strength and flexibility in your back and legs. They can also help manage pain through modalities such as ultrasound or electrical stimulation.

3. Pain Management: Over-the-counter pain relievers or prescribed medications can help manage discomfort. It is essential to discuss any medications with your healthcare provider to ensure they are appropriate for your situation.

4. Activity Modification: Gradually returning to normal activities is important, but it should be done cautiously. Avoid heavy lifting or strenuous activities until cleared by your doctor. Gentle stretching and walking can aid recovery without putting undue stress on your back.

5. Monitoring Symptoms: Keep a log of your symptoms, noting any changes in pain levels, sensations, or mobility. This information can be valuable during follow-up visits to help your healthcare provider understand your recovery progress.

Conclusion
In summary, while it is concerning to experience new symptoms post-surgery, it is not uncommon for nerve recovery to take time. The key is to maintain open communication with your healthcare team, adhere to prescribed rehabilitation protocols, and monitor your symptoms closely. If you have persistent or worsening symptoms, do not hesitate to seek further evaluation. With appropriate care and time, many patients experience significant improvement and return to their normal activities.

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