Our Summary

This research paper talks about a unique case study of a 51-year-old woman who suffered from a nerve disorder in the lower back (lumbosacral plexopathy) two days after undergoing a surgical procedure to remove a herniated disc from her lower back (lumbar microdiscectomy). This is the first reported case of such a complication after this particular surgery. The paper reviews existing research on lumbosacral plexopathy, discusses the best ways to diagnose and manage this condition, and examines possible reasons why it might develop. The study also compares this condition with a similar nerve disorder that occurs in the arm (brachial neuritis) after a surgery to relieve pressure on the neck (cervical decompression). The researchers suggest that both conditions might be caused by an immune system reaction that leads to inflammation.

FAQs

  1. What is a lumbosacral plexopathy and how does it relate to lumbar microdiscectomy?
  2. What is the proposed mechanism linking post-operative brachial neuritis and lumbosacral plexopathy?
  3. How is lumbosacral plexopathy investigated and managed after a lumbar microdiscectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about microdiscectomy is to follow post-operative instructions carefully, including avoiding heavy lifting and bending at the waist for a period of time to allow for proper healing of the surgical site. It is also important to attend all follow-up appointments and communicate any new or worsening symptoms to your healthcare provider promptly.

Suitable For

Microdiscectomy is typically recommended for patients with a herniated lumbar disc causing symptoms such as sciatica or leg pain that has not responded to conservative treatments such as physical therapy, medications, or epidural steroid injections. Patients with symptoms such as weakness, numbness, or tingling in the legs may also be candidates for microdiscectomy. Additionally, patients with severe and debilitating pain that impacts their daily activities and quality of life may also be recommended for this procedure. It is important for patients to undergo a thorough evaluation by a spine specialist to determine if microdiscectomy is the appropriate treatment option for their specific condition.

Timeline

  • Before microdiscectomy: the patient experiences symptoms of lumbar disc herniation, such as lower back pain, leg pain, numbness, and weakness. They may undergo diagnostic tests such as MRI to confirm the diagnosis and determine the extent of the herniation.
  • Day of microdiscectomy: the patient undergoes the surgical procedure to remove the herniated disc material pressing on the nerve root. The surgery is typically done under general anesthesia and involves making a small incision in the back and using a microscope to remove the disc material.
  • Post-operative period: the patient may experience some pain and discomfort at the surgical site, which is typically managed with pain medications. They are usually able to go home the same day or the day after the surgery and are advised to rest and avoid strenuous activities for a few weeks.
  • Two days after microdiscectomy: in the case described, the patient developed a contralateral lumbosacral plexopathy, a rare complication characterized by weakness and numbness in the lower extremities. This complication is unrelated to the initial disc herniation and may require further investigation and treatment.
  • Follow-up care: the patient may require physical therapy or rehabilitation to regain strength and function in the affected limb. Regular follow-up appointments with the surgeon are important to monitor recovery and address any complications that may arise.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with microdiscectomy surgery, including the possibility of developing lumbosacral plexopathy?

  2. How common is lumbosacral plexopathy as a complication of microdiscectomy surgery?

  3. What are the symptoms of lumbosacral plexopathy and how soon after surgery should I seek medical attention if I experience them?

  4. What diagnostic tests may be used to confirm a diagnosis of lumbosacral plexopathy following microdiscectomy?

  5. What treatment options are available for lumbosacral plexopathy, and what is the prognosis for recovery?

  6. Are there any specific factors that may increase my risk of developing lumbosacral plexopathy following microdiscectomy surgery?

  7. How will my post-operative care plan be adjusted to minimize the risk of developing lumbosacral plexopathy?

  8. Are there any steps I can take before surgery to reduce my risk of developing lumbosacral plexopathy?

  9. How will my recovery process be affected if I do develop lumbosacral plexopathy following microdiscectomy surgery?

  10. Are there any alternative treatment options or surgical techniques that may reduce the risk of lumbosacral plexopathy in my case?

Reference

Authors: Tulloch I, Ali R, Papadopoulos MC. Journal: Br J Neurosurg. 2020 Aug;34(4):357-361. doi: 10.1080/02688697.2018.1429568. Epub 2018 Jan 26. PMID: 29373920