Post-Surgery Symptoms After Minimally Invasive Disc Surgery

Herniated Disc - Minimally Invasive Surgery - Unusual Sensation

On January 31, I underwent minimally invasive discectomy for the L4-L5 intervertebral disc.
Upon waking up after the single-level surgery, I immediately felt relief from the nerve compression and limb pain that had been bothering me for five years, especially with recurrent acute inflammatory pain over the past year.
The day after the surgery, I felt almost like a normal person, with only the sensation of having undergone surgery.
I was able to get out of bed and walk with a back brace on the second day, and I was discharged on the fourth day.
From the fifth to the eighth day at home, I continued to feel the same (as if I had returned to my pre-illness state).
Since I couldn't take a shower, on the ninth day, I went out to have my hair washed and unknowingly walked for nearly 30 minutes.
When I returned home, I felt something was off, and the next day I woke up to find that the previous nerve compression and limb pain had returned.
I was extremely disheartened, fearing that I had messed up the surgery.
The next day, I immediately reported this to my doctor, who mentioned that some patients do experience this situation, which is somewhat expected.
I also paid out of pocket for a nerve adhesion prevention gel costing 45,000 TWD.
The doctor explained that my condition was already severely compressed before the surgery, as indicated by the MRI showing complete blockage on the left side.
After the surgery, I felt so comfortable because I had been lying in bed for several days.
However, after returning home on the fifth day, my lumbar spine was subjected to the normal pressures of daily life (gravity), which caused the gel layer meant to prevent adhesions (applied to the intervertebral disc to prevent adhesion with nerves and muscles) to be displaced.
This led to a recurrence of the sensation of nerve compression.
However, as the gel layer is gradually absorbed by the body, the sensation should improve.
Additionally, during the discectomy, a safe margin was maintained, and the gel formed a temporary mechanical barrier, making it unlikely for the disc to herniate again just from walking.
Q1.
Is this explanation reasonable to expect?
Q2.
Is it reasonable to experience nerve compression a week after feeling much better post-surgery?

Mítú gāoyáng, 20~29 year old female. Ask Date: 2012/02/11

Dr. Ding Xianwei reply Neurosurgery

Since I am not a surgeon, I cannot answer your question.
However, based on experience, if the symptoms return to their original state, there are two possibilities: one is that your nerves have been damaged and will not recover; the other is that there has been a recurrence.
Nowadays, surgical methods often only involve removing the herniated disc without damaging the original disc structure, which is beneficial for younger patients due to relatively greater stability and less structural damage, leading to faster recovery.
However, there is a downside: if the disc is not completely removed, the chance of recurrence is relatively higher.
Resting in a supine position is indeed the best posture for spinal rest, and it was those "normal activities" that led to the disc herniation in the first place.
Therefore, if you return to your original lifestyle, the likelihood of recurrence is inherently greater.
Regarding surgical issues, it is best to discuss them thoroughly with your attending physician, and if necessary, further examinations may be helpful.

Reply Date: 2012/02/11

More Info

After undergoing minimally invasive disc surgery, particularly for a herniated disc at the L4-L5 level, it is not uncommon for patients to experience a range of symptoms during the recovery process. Your experience of feeling immediate relief from nerve compression and pain post-surgery, followed by a resurgence of symptoms after a few days, raises important considerations regarding the healing process and the nature of post-operative symptoms.

Understanding Post-Surgery Symptoms
1. Immediate Relief and Subsequent Symptoms: It is typical for patients to feel significant relief immediately after surgery, especially if the procedure successfully decompresses the affected nerve roots. However, the return of symptoms, such as pain or discomfort, can occur for several reasons. One possibility is that the body is still healing, and inflammation can develop as part of the recovery process. This inflammation can lead to temporary nerve irritation, which might mimic the original symptoms.

2. Role of Adhesions and Gel: The use of anti-adhesion gel during surgery is intended to prevent scar tissue from forming between the nerve and surrounding tissues. However, as you noted, the gel can be displaced due to normal activities and pressure on the spine. If the gel is not in place, there is a chance that scar tissue could form, leading to nerve compression again. Your surgeon's explanation that the sensation of compression might return as the gel is absorbed is plausible and aligns with common post-operative experiences.

3. Physical Activity and Recovery: Engaging in physical activities too soon after surgery can also contribute to the return of symptoms. While it is essential to gradually resume normal activities, overexertion can place undue stress on the healing spine. It is crucial to follow your surgeon's guidelines regarding activity levels during the recovery phase.

Addressing Your Questions
Q1: Is this situation predictable?
Yes, it is predictable that some patients may experience a resurgence of symptoms after initially feeling better. The healing process is complex, and various factors, including inflammation, nerve healing, and the potential for scar tissue formation, can influence recovery. Your surgeon's acknowledgment of this phenomenon indicates that it is a recognized part of the post-operative experience.

Q2: Is it reasonable to experience nerve compression symptoms a week after feeling better?
Yes, it is reasonable to experience a return of nerve compression symptoms within a week after surgery. The initial relief you felt could be attributed to the immediate decompression of the nerve. However, as the body begins to heal, inflammation and other factors can lead to temporary symptoms that may resemble the original condition. It is essential to monitor these symptoms and communicate with your healthcare provider about any changes.

Recommendations for Recovery
1. Follow-Up Care: Continue to have regular follow-ups with your surgeon to monitor your recovery. If symptoms persist or worsen, further imaging or interventions may be necessary.

2. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles supporting your spine and improve flexibility, potentially alleviating some of the discomfort.

3. Activity Modification: Be cautious with your activities, especially those that involve heavy lifting or prolonged sitting. Gradually increase your activity level as advised by your healthcare provider.

4. Pain Management: If you experience pain, discuss pain management options with your doctor. This may include medications, physical therapy, or alternative therapies.

5. Patience in Recovery: Understand that recovery from spinal surgery can take time, and it is essential to be patient with your body as it heals.

In conclusion, while experiencing a return of symptoms after minimally invasive disc surgery can be disheartening, it is not uncommon. Open communication with your healthcare team and adherence to post-operative guidelines are crucial for a successful recovery.

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