Patient Question: Disease: Post-Minimally Invasive Lumbar Disc Herniation Problem Description: I am 23 years old, male. Suffered from lumbar disc herniation for more than a year and a half. On the 17th of November this year, I had a quadrant system lumbar disc four or five removal surgery. Post-operative condition is good. I was discharged from the hospital on the fourth day after the surgery. Then on the tenth day, I suddenly had a lot of pain in my back, my back was heavy, I had no strength, and I couldn’t move. Until now, December 9. It has been more than ten days since the appearance of lumbar pain. Now there is a point out of the incision on the left side of the waist, and when I move my waist, it will suddenly have severe pain and sudden muscle spasms. The back is not strong at all. Before the operation, it was pain in the left leg. Now the situation is quite good, occasionally there is a slight swelling and pain. The main thing is that the waist is weak, lift the leg waist pain, force waist incision at a point of pain, a sharp pain to the waist, a sudden muscle spasm feeling, like electric shock. Hope to provide help: Please ask the doctor what I should do and what medication I need to take. Is this a post-operative complication, or is it a nerve adhesion or a muscle adhesion? I would like to ask the doctor for a detailed answer. Treatment process: quadrant lumbar disc herniation four or five removed, back pain at the incision on the tenth postoperative day. No pain without movement. Reply: Hello! According to your description, the possibility of clean L4/5 segment disc removal during surgery is greater, postoperative leg pain relief, at present, the main pain at the surgical opening, to lift the leg and lumbar activities even, common causes are the muscle and ligament tissue around the surgical opening to stabilize the lumbar spine has not healed, perineural hematoma formation, adhesions and edema, general minimally invasive surgery requires wearing a lumbar girth rest for three weeks after surgery to avoid lumbar strain, in order to make the wound heal well, I do not know you I don’t know how you recovered after surgery. In addition, if there is preoperative lumbar instability that is not treated during surgery, intraoperative re-protrusion of the disc in the responsible segment (minimally invasive usually only removes discs that protrude into the spinal canal) or incomplete intraoperative resection, and intraoperative infection can cause the above symptoms. At present, it is necessary to wear a lumbar brace for protection, and bed rest is the mainstay. Oral non-steroidal anti-inflammatory drugs can be taken to inhibit the production of pain-causing substances and nerve-nourishing drugs, and to keep the lumbar area warm. It is recommended to review the MR of the lumbar spine, if it is an infection intervertebral foramen can be flushed, if it is a hematoma, it can be slowly absorbed. Patient question: Is it a serious problem if it is an internal inflammation of the incision? Can the anti-inflammatory injection be taken care of? Reply: If it is really an infection inside the surgical opening, while the surgical opening inside the formation of adhesions wrapped, this situation alone the application of antibiotics may not be effective, the drug in the local concentration is not high, not easy to control, and easy to relapse. You can first review a lumbar spine MR, blood routine, blood ultrasensitive C-reactive protein and blood sedimentation level to identify the cause, and then do targeted treatment. If the symptoms are not very serious, you can also continue to observe and rest more. If it is a sterile inflammatory edema and hematoma compression, it will usually ease slowly. Patient Question: Doctor, this is my post-operative film. But I’ve had an anti-inflammatory injection for five days now, and I don’t feel much effect. I wonder if it could be caused by nerve adhesions? I also have pain in my groin position and up and down my thighs and left abdominal position, and this is the same thing that happens with back pain. Reply: From the MR of your postoperative review, you have a herniated disc in L4/5 segment (central left type), you have done it because it is L4/5 segment, the left side of the plate is opened and decompressed, from the cross-sectional view, L4/5 left lateral saphenous fossa is still narrow, the disc may not be removed cleanly, of course, it may also be an artifact of local hematoma formation. Also, there is inflammation of the endplate cartilage under the L4 vertebral body (not related to surgery), and endplate inflammation can also cause back pain. It is better to upload your preoperative lumbar MR, preoperative lumbar ortholateral + power position (to understand stability), and lumbar CT (to understand whether there is calcification of the herniated disc, and if so, it is difficult to remove it with minimal invasion). Good luck!