Orthopedics-Online

Post nucleotomy syndrome

General

Surgical interventions on the spine after a herniated disc, for example, can lead to pain and functional restrictions.

The so-called post-nucleotomy syndrome describes functional restrictions and pain that can result from a surgical procedure called nucleotomy or discotomy.

In some cases it can be under a Herniated disc there is also the fact that a surgical procedure cannot be avoided, as otherwise irreparable nerve damage threatens, which would lead to paralysis. This procedure (nucleotomy or discotomy) includes the removal of the jelly-like nucleus from the disc.

root cause

There are many possible causes for the development of post-nucleotomy syndrome. These include the following:

Wrong indication for surgery
Operation at the wrong spine height
Insufficient disc relief
Inflammation (s) after surgery

These complications can have fatal consequences for the patient:

Spinal instability
Scarring from impaired connective tissue proliferation
Repeated herniated discs due to tissue changes

Symptoms of Post-Nucleotomy Syndrome

Persistent pain that severely restricts movement is typical of post-nucleotomy syndrome.
Pain in the Lumbar spine-Area, in the hip, leg or knee joint and this pain is comparable in extent to the pain before the operation.
For this reason, it is sometimes mistakenly assumed that the operation has failed and that the pain will persist.
But this is a new cause of pain and therefore also a need for treatment.

For more information about the symptoms of a herniated disc, see:

Symptoms of a herniated disc
- Symptoms of a herniated disc of the cervical spine
- Symptoms of a herniated disc of the thoracic spine
- Symptoms of a herniated disc of the lumbar spine

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A herniated disc is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.

Therefore, treating a herniated disc requires a lot of experience.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Post-nucleotomy syndrome of the lumbar spine

The lumbar spine comprises five vertebrae, which are based on a common basic shape. It connects the thoracic spine with the sacrum (Sacrum). Due to its anatomical position at the lower end of the spine, it cushions weight and movement loads to a particularly high degree. Therefore, the lumbar spine can be more prone to damage, such as Herniated discs, be. Typically, 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 sensory pathways that run through the spinal cord and its nerve roots are damaged by a herniated disc, both arise sensitive discomfort as well as motor failures and Paralysis. One possible treatment for a herniated disc in the lumbar spine is Nucleotomy, in which those parts of the intervertebral disc that protrude into the spinal canal and compress the spinal cord and nerve roots are removed. After such an operation, burning and diffuse lower back pain can occur, even though the herniated disc has been resolved. One then speaks of Post nucleotomy syndrome. Because the lumbar spine is quite often affected by a herniated disc compared to other parts of the spine, it is also more exposed to surgical procedures that increase the likelihood of one Post-nucleotomy syndrome increase.

Pain in post-nucleotomy syndrome

The pain is partially resistant to therapy.

The Post nucleotomy syndrome is characterized by persistent, i.e. persistent pain, which can be more or less resistant to therapy. The operation creates new causes of pain instead of eliminating all complaints as intended. The pain is diffuse, burning and stabbing. It is believed that they are caused by an increase in tissue in the operating area. It comes to Scarring and Nerve irritation after the operation, which are involved in the development of pain. There are other causes of the pain as well. The scar formations lead to Bonding between different connective tissue and bony parts of the spine, spinal canal and spinal cord. As a result of the operation, the spine can show instabilities at the operated site, which injure the nerve roots. Other psychological and physical factors are involved in causing the pain Post nucleotomy syndrome discussed. If the vertebrae become painfully wedged into one another by removing the damaged intervertebral disc, one speaks of "Telescoping". As a rule, this painful syndrome arises from complications during the operation or from incorrect indications. The risk can therefore be reduced through 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) pain relievers and behavioral therapy treatments. 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 any therapy.

Time of occurrence

In general, it cannot be said when these symptoms will appear after the operation. However, important documentation of the time of occurrence is important for therapy and prognosis, which is why it is necessary to carefully observe how the pain develops in the period after the operation.
An indicator of the presence of a post-nucleotomy syndrome is the perceived persistence of the original symptoms even after the operation. The recurrence of protruding discs or herniated discs (re-lapse) also speaks for the post-nucleotomy syndrome.

Prevention

The most common cause of post-nucleotomy syndrome is acting too soon, before the exact cause of the pain has been determined. An accurate and correct diagnosis and a careful assessment of the benefit and risk of the operation is therefore the most effective prevention against post-nucleotomy syndrome.

Detailed discussions with the attending physician (orthopedic surgeon or neurosurgeon) are absolutely necessary before the operation, unless it is a rare emergency that needs to be operated on immediately.

therapy

Post-nucleotomy syndrome can only be treated surgically in exceptional cases. Possible surgical treatment options here would be renucleotomies, stiffening, stabilization or the use of Intervertebral disc prostheses.

In most cases, however, only conservative therapy methods (for example in the form of medication) are available to treat chronic pain.

The first choice here are those that appear peripheral Painkiller (Analgesics) called non-steroidal anti-inflammatory drugs (NSAIDs). Treatment with muscle relaxants or centrally acting analgesics is also possible. In this therapy for chronic pain, careful attention must be paid to any possible dependence on pain medication and for this reason, the treatment must be carried out by an experienced pain therapist or in a pain clinic.

Further, special therapy for pain is a special medical field and requires a lot of experience, as very individual combinations of different therapies for pain are usually used. This approach (combination concept) is referred to as multimodal and means that the pain is specifically addressed in parallel with different therapies.

The following methods are available for this: