The so-called postnucleotomy syndrome refers to functional limitations and pain that can result from a surgical procedure called nucleotomy or discectomy. In some cases, a herniated disc can lead to a surgical intervention that cannot be avoided, as otherwise there is a risk of irreparable nerve damage that would result in paralysis. This intervention (nucleotomy or discectomy) includes the removal of the prolapsed gelatinous core of the disc.
Cause
There are many possible causes for the development of postnucleotomy syndrome. Among them are the following: These complications can develop into fatal consequences for the patient:
- Wrong indication for surgery
- Surgery at the wrong height of the spine
- Insufficient disc relief
- Inflammation(s) after surgery
- Instability of the spine
- Scarring due to impaired connective tissue proliferation
- Repeated slipped discs due to tissue changes
Symptoms of postnucleotomy syndrome
Persistent pain that severely restricts movement is typical of postnucleotomy syndrome. Pain in the lumbar spine area, hip, leg or knee joint is characteristic, and the extent of this pain is comparable to the pain before the operation. For this reason, it is sometimes wrongly assumed that the operation has failed and the pain will persist. But this is a new cause of pain and therefore a need for treatment.
Postnucleotomy syndrome in the lumbar spine
The lumbar spine consists of five vertebrae, which are based on a common basic form. It connects the thoracic spine with the sacrum (Os sacrum). Due to its anatomical position at the lower end of the spine, it absorbs weight and movement loads to a particularly high degree.
The lumbar spine can therefore be more susceptible to damage, such as herniated discs. Classically, herniated discs occur in the lower sections of the lumbar spine and, depending on which nerve root is affected, lead to characteristic symptoms. Since the motor and sensitive pathways that run through the spinal cord and its nerve roots are damaged by a herniated disc, both sensitive sensations and motor deficits and paralysis occur.
One possible treatment for a herniated disc in the lumbar spine is nucleotomy, in which those parts of the disc that extend into the spinal canal and compress the spinal cord and nerve roots are removed. After such an operation, burning and diffuse back pain may occur even though the herniated disc has been removed. This is called post-nucleotomy syndrome.
Since the lumbar spine is quite often affected by a herniated disc compared to other parts of the spine, it is also more often exposed to surgical interventions, which increase the probability of the occurrence of postnucleotomy syndrome. Postnucleotomy syndrome is characterized by persistent, i.e. persistent, pain, which can be more or less resistant to therapy. The operation therefore creates new causes of pain instead of eliminating all complaints as intended.
The pain is diffuse, burning and stabbing. It is assumed that they are caused by tissue proliferation in the surgical area. Scarring and nerve irritation occur after the operation, which are involved in the development of pain.
In addition, there are other causes of pain. Scarring leads to adhesions between different connective tissue and bony parts of the spine, spinal canal and spinal cord. As a result of the operation, the spinal column may show instabilities at the operated area, which injure the nerve roots.
Other psychological and physical factors are discussed in the development of pain in postnucleotomy syndrome. When the vertebrae painfully wedge into each other due to the removal of the damaged intervertebral disc, this is called “telescoping”. Usually this painful syndrome is caused by complications during surgery or by false indications.
The risk can therefore be reduced by a strict indication. However, other factors (see above) also play a role in the development of the pain.The therapeutic approaches include both mild to strong (e.g. morphine) painkillers and behavioral therapy. The latter are implemented, for example, in patient training and pain management training. Overall, however, the pain is very resistant to therapy and in some cases completely eludes all therapy.
