What Are the Symptoms of Nerve Damage After Back Surgery?

Whenever you decide to undergo surgery, you’re accepting a degree of risk. Thankfully, with experienced surgeons and proper pre- and post-operative care, these risks are usually outweighed by the benefits of the procedure. However, before undergoing back surgery, patients are often (understandably) concerned by the risk of nerve damage. 

Back surgery involves operating around the spinal cord and surrounding nerves, posing the risk of nerve damage. Understanding the symptoms of nerve damage after back surgery can help you seek the appropriate care and mitigate your risk of long-term complications. 

Risks Associated with Spinal Surgery

The risks associated with spinal surgery include infection, bleeding, blood clots, reactions to anesthesia, dural tear, and nerve damage. 

  • Infection is a risk associated with any surgical procedure, including spine surgery. However, it’s considered a rare complication, occurring in less than 1% of spine surgeries. Postoperative infections usually develop within three days to three months after the procedure. 
  • Bleeding is another possible risk of surgery. The more invasive the procedure, the higher the risk of blood loss – it’s more likely in spinal fusion, for example, than minimally invasive procedures. However, your surgeon will work to manage bleeding and prevent significant blood loss throughout the surgery. 
  • Blood clots (also known as deep vein thrombosis, or DVT) are a possible surgical complication, although the risk is low, especially with minimally invasive spine surgery. However, contact your doctor immediately if you experience any signs of a blood clot after surgery, such as:
    • Leg pain or tenderness
    • Swelling or warmth in the leg
    • Red or discolored skin on the leg
    • Prominent veins on the leg
    • Shortness of breath
    • Sudden chest pain 
    • Pain while breathing
    • Coughing up blood 
  • Anesthesia side effects can range from nausea and sore throat to more serious complications, like confusion, memory loss, and malignant hyperthermia. Though still relatively rare, general anesthesia is more likely to cause side effects than local anesthesia. 
  • Dural tear is a tear in the dura mater, the thick membrane that encases and protects the spinal cord. Surgical procedures create the risk of dural tears, which can lead to persistent headaches, dizziness, nausea, and pain. However, this complication is considered relatively rare, especially when you visit an experienced, qualified surgeon. 
  • Nerve damage is possible during any spinal surgery, as the surgeon must operate near the spinal cord and nerves. One potential complication is damage to the nerve lining, which can lead to cerebrospinal fluid (CSF) leakage. Possible CSF leak symptoms include headaches, dizziness, liquid leaking out of the nose or ears, lost sense of smell, hearing changes, blurred vision, nausea, light sensitivity, and balance issues. 

How To Lower Your Risk of Complications From Spinal Surgery

While some accidents are unavoidable, you can significantly reduce your risk of spinal surgery complications by:

  • Quitting smoking
  • Reaching a healthy weight
  • Ensuring any underlying medical conditions, like hypertension, are properly managed before the surgery
  • Following all of your surgeon’s preoperative instructions
  • Choosing a licensed, qualified spinal surgeon who’s experienced in the procedure you’ll be getting
  • Carefully observing your condition after the procedure and contacting your doctor about any concerning symptoms

Causes of Nerve Damage During Surgery

The possible causes of nerve damage during surgery include accidental injury to a nerve or myelin, inflammation, prolonged retraction, improper positioning, and anesthesia complications. 

  • Accidental cutting or severing of nearby nerves of myelin (the sheath that surrounds nerves and preserves proper nerve function) can lead to nerve damage during surgery. 
  • Nerve inflammation or bruising from the trauma of surgery typically resolves during the healing process, but can lead to lasting neurological symptoms in some cases. 
  • Prolonged retraction refers to tissues being pulled back for a prolonged period to improve access to the surgical site. In some cases, this triggers nerve damage.   
  • Improper positioning on the surgical table can lead to nerve damage. Remaining in one position for too long during the procedure can compress certain nerves. 
  • Anesthesia can cause nerve damage, although this is very rare. This typically occurs if the patient remains in an awkward position while under general anesthesia, leading to nerve compression.  

What Are the Stages of Nerve Healing After Surgery?

The stages of nerve healing after surgery include inflammation, nerve regeneration, and restored sensation. It can take a few weeks, a few months, or up to a year for nerves to heal after back surgery, depending on the severity.  

How Can You Tell If You Have Nerve Damage After Back Surgery?

You can tell that you may have nerve damage after back surgery if you experience neurological symptoms, such as:

  • Burning, tingling, or numbness
  • Pain that radiates from the back to the extremities
  • Muscle weakness, particularly in the legs and feet
  • Difficulty walking and balancing
  • Changes in your gait

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Post-Laminectomy Syndrome Symptoms

Post-laminectomy syndrome symptoms include:

  • Chronic back pain
  • Sharp, burning, stabbing, or pricking pain (often called “neuropathic pain”)
  • Pins and needles sensation
  • Radiating pain
  • Difficulty with balance, walking, or coordination
  • Leg weakness
  • Muscle spasms

Post-laminectomy syndrome occurs when back pain returns after back surgery, and it’s also referred to as failed back surgery syndrome, or FBSS. 

Preventive Measures for Nerve Damage

Preventative measures for nerve damage include choosing minimally invasive treatments, selecting a highly qualified spinal surgeon, quitting smoking, exercising regularly, and managing underlying medical conditions. 

  • Choosing minimally invasive treatments for back pain and spinal conditions can help prevent nerve damage. These treatments involve significantly less tissue disruption and trauma to the affected area, which limits the risk of complications (including nerve damage). 
  • Selecting a highly qualified spinal surgeon with years of experience and excellent testimonials can help ensure the procedure is completed properly. Your surgeon can also perform various tests before the procedure to identify risk factors for nerve damage and plan accordingly. 
  • Quitting smoking can help protect your nerves by promoting blood circulation. The nicotine in cigarettes, vapes, and related products constricts your blood vessels, stifling circulation throughout your body. This lack of blood flow increases your risk of nerve damage. 
  • Exercising regularly supports healthy blood flow, ensuring your nerves receive ample oxygen and nutrients. Exercise also encourages your body to release certain neurotrophic factors that support nerve regeneration. 
  • Managing underlying medical conditions can help lower your risk of nerve damage from back surgery. Properly managing diabetes, in particular, is essential to prevent diabetic neuropathy. 

Treatment Options for Nerve Damage

Treatment options for nerve damage after back surgery include physical therapy, medications, spinal cord stimulation, and reoperation. Healthy lifestyle adjustments, like nutrition, exercise, and good posture, can amplify the benefits of these therapies.

  • Physical therapy is a non-invasive method that helps improve muscle strength, range of motion, and overall bodily balance. This can promote nerve recovery over time. 
  • Medications including non-steroidal anti-inflammatory drugs, antidepressants, anticonvulsants, and epidural steroid injections can help reduce the symptoms of postoperative nerve damage, although they’re generally not recommended for long-term use. 
  • Spinal cord stimulation involves surgically implanting a device into the spinal cord to block pain signals. It can be used to treat chronic nerve symptoms that don’t resolve with conservative methods. 
  • Reoperation may be considered to address chronic nerve pain when conservative therapies fail after several months or years. Physicians try to exhaust all other treatment options before turning to reoperation for neurological symptoms. 

Seek emergency medical care if you experience symptoms of severe nerve damage, like lost bowel or bladder function, vision changes, or slurred speech.