Issues after spinal anesthesia

[jill915]

I am a 45 F and had a TKR two months ago.  I had spinal anesthesia and was also "out" during the surgery.  I was catheterized during the surgery until the following morning.  I have had ongoing issues with my leg, EMG/NCS last week were positive for significant femoral nerve damage (possibly from the tourniquet??), as well as being "positive" in my spine - although that doctor did not explain about my spine and my f/u with my OS is tomorrow.  

Since my surgery I haven't been able to lift my leg or foot even in the slightest way, a section at the top of my thigh is completely numb, my back has been very sore, and when I go to the bathroom, I only ever "trickle" - no matter how "bad" I have to go.  I'm trying to put the pieces together with the use of the internet.  

Are the urinary issues and numbness a symptom of the damaged femoral artery or the issue in my spine?  I am supposed to undergo a "manipulation under anesthesia" (spinal anesthesia) in an attempt to get more range of motion (I can only bend to about 40 degrees), but I am nervous about another epidural.  I'm not even certain at this point what questions I should be asking my surgeon tomorrow.  

Any advice or guidance would be greatly appreciated.  Thank you.

Jill

[jill915]

I had my f/u with my OS after my EMG/NCS last week. I'm going to list here what my report says. I've looked up some of the medical terms... and it is a bit terrifying. My doctor is at a loss that so many issues have surfaced since my LTKR. I have been referred to a spine specialist and have been scheduled for an "emergency" CT scan of the lumbar spine for Monday morning at 9am. He also said that due to the femoral nerve damage and the approx 50% motor loss to the vastus medialis (inner thigh muscle) he was not going to perform the manipulation, as there was too much damage to the nerve and muscle to sustain any flexion that he might achieve. Also, because of the spine issues found, he said he didn't want anyone sticking anything into my spine until we found out what was going on. At no time were lesions or tumors talked about during my visit, however, as the findings below note, it couldn’t be ruled out.

1. Abnormal Study.

2. Likely left femoral neuropathy proximal to the motor branch of the iliopsoas; with approx 50% motor axon loss to the vastus medialis, prognosis for functional recovery good if instigating lesion is removed.

There is electrophysiological evidence of a left-sided femoral mononeuropathy as shown by the abnormalities on needle EMG of the left iliopsoas, vastus medialis which is clouded by the abnormalities throughout the rest of the left lower limb and in the right as below.

3. Possible left and possibly right L5 or S1 radiculopathy, plexopathy, cannot rule out left lumbosacral panplexopathy.

There are diffuse abnormalities on needle EMG throughout the left lower limb w/ sparing of paraspinals. A panplexopathy cannot be excluded in this situation. However, there is an alternative more likely explanation for the proximal left lower limb symptoms as above. The remainder may be explained by an L5 or S1 radiculopathy or plexopathy. Abnormalities were seen in the tibialis anterior on the right side and there may be a similar but lesser process on the right.


Clinical Impression: Test shows what is likely a left femoral neuropathy with approx 50% motor axon loss to the vastus medialis. If this is related to a one-trauma the prognosis is good. Recovery usually takes place at 1 inch per month as a very rough estimate, and recovery could therefore take a year or even longer. There was no current evidence of axonal sprouting or regrowth.

There are diffuse abnormalities thruout the left lower limb and even some on the right. This may be due to a bilateral L5 or S1 radiculopathy, though a panplexopathy on the left cannot be excluded. Imaging of the lumbosacral spine and pelvis should be considered.


If anyone here can decipher any of the medical jargon and give me their thoughts in "normal people" speak, I'd appreciate it. I gather that they are looking for/ruling out a tumor on my spine (trying not to freak about that).

[squirtatious]

Manipulation under anesthesia? That would make me run far and fast!!!!! Have u been checked for cauda equina? I would definetely get 2nd and 3rd opinions, I wish u well!!