[Rehabilitation / Postoperative Spine Surgery Questions] 10 weeks post op, Atrophy and weakness not yet improving??

[tonydisc]

Hi,

First, some of my history:

I herniated my C5/6 pretty bad at the beginning of this year. After a couple of weeks of extreme pain, the pain improved dramatically then pretty much went away 90%, but I was left with arm weakness and some muscles started to very rapidly atrophy.

I had surgery after waiting 8 weeks for this to imrprove. I did not have fusion, I had a posterior Microdiscectomy, the neurosurgeon just went in the back of my neck and cleaned up around the bad disc then closed me up. My disc was not removed, and I did not get fused.

I am now 10 weeks post surgery, and its been 18 weeks since injury. My main concern is that my strength and muscle mass has not returned since surgery. I recovered from surgery fairly fast and was running and doing light gym again at the 6 week mark without pain.

Is there anyone else who went through something similar? It feels weird to me that there is not at least SOME sign of improvement. But is it possible that somewhere down the line my muscles will suddenly start to grow back out of the blue, or does the lack of any improvement at this point mean things will never get better?

Thanks.

[thumoeides]

I had strength return in the triceps, as tested by the surgeon, straight away after surgery. Strength was returning already before surgery, and has returned more after surgery, in the wrist extensors and pectoral muscle. But I have not had any return in size. I am only one week post surgery, and I have not been doing any weights while I am waiting to heal, so I shouldn't expect any growth in muscle size. I may start light weights in a couple of weeks, and I expect it will take a while for muscles size to return. The size difference in my right and left triceps is visible, and is the right and left pectoral muscle, but I wouldn't say 40% difference from right to left. Maybe 20%.

I have soreness especially in the triceps but also in the arm and shoulder. The triceps is sore to the touch and when I extend it. The surgeon says that is a sign of the muscle coming back after being damaged along with the nerve. Nerves grow really slowly. The shoulder and arm soreness come and go.

I would think that since you had surgery after only eight weeks, I had surgery after 14 weeks, you should have a good chance of full recovery. But that your pain went away 90% is concerning. That is a sign the nerve is dying. Do you have any soreness in the muscles? Do you feel any pain in the nerves that were painful before?

The surgery you had has the disadvantage that the disc space is not distracted and the associated collapse that happens with a disc herniation can continue and place pressure on the nerve in the foramen (where the nerve exits the spine).

What does your surgeon say?

[tonydisc]

Really is it a bad sign my pain went away???

I thought it was normal for pain to go away first. I also had numbness in my thumb, but that has almost gone now too. Its just the weakness and atrophy that remains now.

The surgeon said, lets just wait and see what happens since everything that can be done has been done, so not its a matter of time. I thought that sounded ok, but was hoping for more results by the 18 week mark than this. I guess I was hoping for what you got - an immediate increase in strength once the surgery was done. I never got that, and could never figure out why. None of my muslce are sore to the touch, although there is a strange feeling of internal pressure in the affected arm when I move it, it does not feel good.

Do keep me up to date on how you go.

PS how big was your herniation? Do you have any pictures? Mine was pretty big.

thanks for the reply.

[thumoeides]

Well, it depends on why the pain went away. If it was the nerve healing, good, if it was the nerve dying, bad. I just worried that combined with weakness it might be the nerve dying. But if your numbness has gone, that is good.

I think any weird feelings in the arm are good, a sign the nerve is firing. Nerves grow really slowly, and when it comes back depends on how bad the damage was. It could take 18 months. I think doctors don't really know much about nerves, and there are some amazing stories of people getting strength back after losing all use of an arm. But cases in which there is weakness and not a lot of pain are especially unusual.

I don't know how big my herniation was. I know the disc simply burst, and the surgeon was cleaning bits of it off the nerves. There was no way I could have had your operation, which I take it is reserved for bulging discs rather than ones that have burst and extruded into the nerve space.

[jss]

Tony,

Condolences on your motor impairment. I can't answer any of your questions, but as I've had four cervical surgeries now, and as my second one generated the same symptoms that you've just experienced, I can share that experience with you.

I was at my 20 year high school reunion in 2001 when I suddenly lost use of my right arm. No pain, tingling or numbness. I was holding a glass of water in my right hand; it began to slip and I caught it with my left. By the end of the evening I was unable to shake hands, hug someone I hadn't seen over the past decade, or even raise my right arm up to my face.

With therapy the symptoms began to resolve. Within a month I was able to comb my hair, and within another month I was able to brush my teeth. I had a fusion (C5/6) in January 2002. Within a month, except for spasms, all symptoms resolved. Today (two surgeries and 7.5 years later) I can even do ten pull ups.

I would have expected that you would be seeing some resolution of your motor impairment by now. I was 37-38 when all of that occurred. How old are you?

Good luck, Jeff

[thumoeides]

Jeff,

Why did you have the fusion if your symptoms resolved with therapy? You reached a plateau with the therapy beyond which no improvement?

How long from loss of use of your arm until surgery?

Steve

[jss]

Steve,

The symptoms did not completely resolve pre-surgery. It was a few weeks post surgery that motor impairment resolved. From the onset of symptoms until surgery was almost exactly six months. From surgery until I regained complete use of my right arm was almost three months.

[thumoeides]

Jeff,

So I take it in between resolution of motor impairment and regaining full use of your arm you had muscle spasms and pain. Could that be caused by the process of reinnervation?

My GP speculated that weakness without prior pain can happen when the nerve damage occurs quickly. But I wonder whether recovery must go through the pain period?

A second question if you don't mind: did your muscles noticeably decrease in size before they finally came back? What exercises did you do in the recovery period?

[jss]

Steve,

I had muscle spasm and pain for about three years after the second fusion. It was so bad at one time that I thought I had another disc problem. Could pain and spasms after nerve decompression be caused by the affected nerve healing? Perhaps, I don't know. The only time I was in debilitating pain was prior to my double ADR in 2009. That pain went on for three months, and unlike the two fusions, with the ADRs I've had no pain or spasms since I woke up in recovery.

I know that the muscles in my right arm did atrophy prior to the second fusion, but I don't recall that they actually wasted and got smaller. I did try to continue using that arm as normally as was possible through the weakness. I did not do any post-surgical exercises to redevelop the muscles (though that probably would have been an excellent idea). I recall that my left arm was significantly stronger for some time post surgery... I don't recall how long it too the arm to strengthen to its pre-problem levels.

Jeff

[KanRunMo]

JSS,
Where did you get your two level ADR? Besides the DDD etc., I also have pain in my right arm and hand though mainly at night. I hadn't related it to the back but now realize it probably is. Sounds like ADR has been the best solution for you.