POST-OP NUMBNESS FOLLOWING ALIF

  Two weeks ago, my brother underwent a two-level Anterior Lumbar Interbody Fusion with Synthes Femoral Ring Allografts at L4/5 and L5/S1 with interlocking screws at each level.  Immediatelty following, he was turned on the Jackson Table and had translaminar titanium facet screws placed in a criss-cross manner at L4/5 and vertically at L5/S1.   This procedure was following a failed lami/diskectomy 3 yrs ago at L5/S1 with recurrent herniation at that level, and a new herniation at L4/5.  Since his surgery, in addition to his pre-surgical symptoms of right leg numbness/weakness, he has developed new symptoms which include pain in the left buttocks, bilateral inner thigh numbness, pain in the scrotum, and numbness on the right scrotum and right side of his penis.  Today we went for his two week post-op check with new xrays, and due to his symptoms a MRI with gado was performed.  The MRI showed nothing, and the plain films which included supine ap/lat, upright, and angled ap/lat showed good alignment of the grafts and screws.  This surgeon (whom I worked for up til last week) seemed to take these symptoms lightly and in his sarcastic way, jokingly suggested a psych consult.  I am very concerned that although it would be unethical, he may be holding back on the care of my brother because of his anger with me for resigning from my position in his office (bad timing).  Although I have no real medical training, other than working for various doctors offices for the past 18 years, it seems that something more should be done and/or considered now, before any permanent nerve damage may result.  I am pretty connected in the medical field, and do know of another surgeon who could see my brother for a second opinion but cannot get him in to see this surgeon until March 10th, and all the neurologists in the area are booking into May.  Is this something that can wait?  ...or should we just go to the emergency room and have him evaluated by a neurologist on call?  Any ideas what may be the cause of this and where to go with this one?    Thanks, AM

[CCF NSG MD / gsh]

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Dear Anne Marie,
These are difficult questions to answer due to the sensitive nature of the situation.  Let it suffice to say that if you are not comfortable with the opinion of your present surgeon, a second opinion is usually the next step.  This can add reassurance to the patient that the right things are being done.
Presumably, if there were any residual or new compression on the neural structures, it would show up on the MRI.  If the symptoms seem to be stabilizing or improving, it is likely not going to be such an urgent issue.  If, however, the symptoms are worsening, then the second opinion should be sought sooner.
Lastly, if you don't like a surgeon, then don't let him or her operate.  Find someone you are comfortable with and go from there.  You will be happier in the end.
Good luck.