Why does my friend have numbness after hemilaminectomy surgery?

Q. Why does my friend have numbness after hemilaminectomy surgery?

Answered by
Dr. Berry Chirag Ashok
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jul 13, 2016 and last reviewed on: Jun 20, 2023

Hello doctor,

I am inquiring for a friend who underwent L4 - L5 hemilaminectomy surgery. He is recovering except for the persistent numbness, pins and needles and swelling in his left foot. It is more pronounced in the afternoon to evening. He is a teacher by profession. He has reported this to his doctor, but his doctor has no answer to the numbness, and just asked him to report to him every now and then and wait for complete recovery. This is why we are reaching out at least to get an opinion or advice what could the symptoms be. Is it normal and how long will he have this? Meantime, what can he do to ease the symptoms? Many thanks.



Welcome to icliniq.com.

It sounds like your friend is bothered by the persistent tingling and numbness in his left foot. I understand these sensations can be quite irritating, especially if your work involves standing for long periods. Did he have these tingling sensations in the same areas before the surgery? If so, have these worsened after the surgery or remained the same? I assume his symptoms before the surgery were also on the left side and his hemilaminectomy was also performed on the left side. It will be nice if I could see the preoperative MRI images to see what the hemilaminectomy was done for. Often, if the surgery involves removal of a large herniated disc or the space available for the nerve is very less (stenosis), then the nerve may get bruised during surgery due to retraction. This means that, in order to decompress the nerve, the surgeon has to retract the nerve to go around the nerve and remove the compressing elements. If the compression is severe, the nerve gets bruised easily and there may be persistent numbness and tingling in the areas of the leg and foot that are geographically supplied by that nerve. Since the surgeon has advised him to wait it out, I assume this is likely the case. Swelling of the foot is common if the nerve supplying that area is not fully functional. The weak muscles in the leg and foot are not able to push the blood back up towards the heart and gravity causes this dependent area to swell up. This is often seen at the end of the day and gets better at night when he sleeps.

It is difficult to predict how long the tingling will last. It could be a few months. The fact that there is tingling and not pure numbness is actually encouraging, although it is more irritating to the patient. If it were a complete nerve injury, then only numbness would be experienced. The presence of tingling means that the nerve is just irritated, inflamed and swollen due to the bruising. If the tingling is very bothersome, he may try some neuralgic pain medications like Gabapentin or Pregabalin. Nonsteroidal anti-inflammatory medications (NSAIDs) may also help in this situation. There is a very rare possibility of other complications like recurrent disc herniation, other post-surgical changes irritating the nerve, etc. These are difficult to diagnose and usually need a new MRI with contrast. However, it is advisable to delay such investigation for at least for two to three months after surgery, since the MRI images at this stage will be obscured by the post surgical changes. If the symptoms of tingling and numbness are progressively worsening and if he develops back pain, a new MRI may be needed irrespective of the time since surgery to rule out infection or instability.

The Probable causes:

Surgical retraction of nerve that may have caused it to bruise.

Investigations to be done:

None, if symptoms are not progressively worsening.

Differential diagnosis:

Recurrent disc herniation.

Treatment plan:

Gabapentin or Pregabalin and NSAIDs.

Thank you doctor,

Your comprehensive explanation was very much helpful. The numbness or tingling and swelling are all new experiences for him. Presurgery his pain was on his lower back radiating to his left pelvis, buttocks and left leg. It was definitely bad before surgery. The current experiences are quite unsettling for him, because he is an active person and it often depresses him. As a form of exercise, he tries to walk as much and reaching 2.48 mile on weekends. It gives him a lot of comfort and he feels like he can just go on. But, he also does not want to push it. He walks with some limps and cannot still walk in a balanced manner. I will try to get the copies of his x-rays or MRI and will send to you. We look forward for any additional information you can provide us.



Welcome back to icliniq.com.

Glad to know my response was helpful. From what you have mentioned, it seems that your friend had a severe radiculopathy (radiating pain down the left leg) prior to surgery and that has now transformed to numbness, tingling and heaviness. Bruising from nerve retraction seems to be a likely cause, but I am not sure. As I mentioned, medications like Gabapentin or Pregabalin will likely help with his tingling sensations. It is understandable that he feels depressed as these symptoms can be quite bothersome. If the tingling sensations are painful he may consult a pain physician to try some other medications as well. Some medications like Amitriptyline, that are primarily used as antidepressants, have been tried in lower doses to help with this neuralgic pain. His muscle weakness, swelling and difficulty with walking should hopefully get better with time and I can only suggest that he has patience with it. Walking is definitely good. if he likes it. If he has had a discectomy with his hemilaminectomy, I would strongly recommend avoiding lifting weights more than five pounds and avoid excessive bending and twisting of his lower back to avoid any recurrent disc herniation. Also, I would suggest that he maintains close follow up with his surgeon so that his neurological recovery will be well monitored.

Thank you doctor,

I am attaching all the medical records of my friend. His MRI was presurgery. Other records are during and post (X-ray was during). All are with his consent. He suffered slipped disc eight years ago. He had the intermittent pain all these years, but would just managed. Last year as the pain was more persistent, it did not go away for around three months and were debilitating, hence he opted for surgery. He plays tennis prior to surgery and is very curious to know if he can ever play again.



Welcome back to icliniq.com.

Looks like your friend has had a transforaminal endoscopic discectomy (attachment removed to protect patient identity). Without seeing the full operative report, I cannot be sure if he also had a hemilaminectomy through a different incision, as you mentioned in your first message. Can you check with him if he has two sets of incision in his back, one closer to the midline and another a few inches to the left of midline? From his MRI report, I gather that his disc herniation was predominantly paracentral causing stenosis in the lateral recess region. This is most often taken care of with a hemilaminectomy or a laminotomy. I would still give it another month and a half before investigating with a repeat MRI with contrast if the tingling and numbness does not go away. Till then, I would suggest sticking to the plan as I mentioned in my previous messages. About his ability to play tennis, it is probably too early to say. But in the most probability, he should be able to do so in due coarse of time. His muscle strength, I assume, is well maintained as he can walk for long distances. A detailed evaluation by a physical therapist may give us an idea of his current muscle strength and persistent therapy should help in rehabilitating him to as close to normal function as possible.

Investigations to be done:

MRI with contrast, if tingling and numbness does not improve three months after surgery.

Probable diagnosis:

Nerve injury possibly due to surgical retraction and manipulation.

Thank you doctor,

According to my friend, endoscopic procedure was first tried and the doctor said that the muscle or something will prove to be hardened, they will proceed with the hemilaminectomy. I am forwarding his operative record which he sent me today. I hope this gives complete histroy of his medical record and will prove helpful for further reference.



Welcome back to icliniq.com.

Thanks for uploading the operative record (attachment removed to protect patient identity). Now I think I have a better picture, and it makes complete sense. The surgeon did the right thing by changing his plan to a open hemilaminotomy. The protruded disc was probably too large and the nerve may have been retracted to allow the surgeon to get around it to remove the disc fragments. As I suggested previously, your friend can continue with his physical activities of walking, probably do some physical therapy, rehabilitation and give the nerve some time to heal itself. I am optimistic that his symptoms will eventually get better.

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